Video Telehealth Tablet Initiative Improves Access to and Continuity of Mental Healthcare for Veterans
BACKGROUND:
Of the approximate nine million enrolled Veterans receiving VA healthcare, nearly one-third live in rural, highly-rural, and insular island areas, and many others experience transportation and financial challenges that are deterrents to using VA care. These barriers are further compounded for the 2 million Veterans with mental health conditions, some of whom avoid care due to perceived stigma or privacy concerns. In 2016, VA initiated a program to distribute video-enabled tablets to Veterans with geographic, clinical, or social access barriers to in-person care so that they could receive services in their homes or other convenient locations: 75% of tablet recipients had a mental health diagnosis, providing a unique opportunity to assess the effectiveness of this national dissemination of tablets. Thus, this study evaluated the implementation of this initiative for Veterans with mental health conditions, including the association of tablet receipt with access and continuity of mental health care, missed opportunities for care, and use of urgent care. Study investigators matched tablet recipients with mental health diagnoses (n=728) to a comparison group (n=1,020) based on sociodemographic characteristics, mental health diagnoses and care, and wireless coverage.
FINDINGS:
- Distributing video-enabled tablets to Veterans with mental health conditions appeared to improve access to and continuity of mental health services while also improving clinical efficiency.
- Compared to the control group, tablet recipients experienced an increase of 1.9 psychotherapy encounters; an increase of 1.1 medication management visits; a 19% increase in their likelihood of receiving recommended mental healthcare continuity; and a 20% decrease in their missed opportunity rate (i.e., missed appointments) six months post-tablet receipt.
- There were no significant differences in emergency department or urgent care use between groups.
IMPLICATIONS:
- VA's telehealth tablet initiative may serve as a model for other large integrated healthcare systems aiming to address access barriers through virtual technology.
NOTE:
- An ongoing evaluation is examining Veterans' experiences with the tablets, including their preferences for virtual vs. in-person care and their reported money and time savings.
LIMITATIONS:
- Investigators were unable to assess Veterans' use of healthcare services not covered by VA.
AUTHOR/FUNDING INFORMATION:
This study was funded by VA HSR&D's Quality Enhancement Research Initiative (QUERI) e-Health Partnered Evaluation Initiative. Dr. Jacobs is part of HSR&D's Health Economics Resource Center (HERC), and all other authors are with HSR&D's Center for Innovation to Implementation (Ci2i).
Jacobs J, Blonigen D, Kimerling R, Slightam C, Gregory A, Gurmessa T, and Zulman D. Increasing Mental Health Care Access, Continuity, and Efficiency for Veterans through Telehealth with Video Tablets. Psychiatric Services. August 5, 2019; Epub ahead of print.
