Expansion of Telehealth Availability for Mental Health Care After State-Level Policy Changes From 2019 to 2022.
Expansion of Telehealth Availability for Mental Health Care After State-Level Policy Changes From 2019 to 2022.
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DOI：
10.1001/jamanetworkopen.2023.18045
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发表时间：
2023-06-01
影响因子：
13.8
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中科院分区：
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这项队列研究评估了新冠肺炎大流行之前和期间美国精神卫生治疗机构的远程健康使用情况和可获得性。2019年至2022年的州级政策变化是否与全美心理健康治疗机构远程医疗服务的扩大有关？在这项对12家 828家精神健康治疗机构进行的队列研究中，4项与支付平价、纯音频远程医疗服务报销和州际许可证契约有关的州政策与美国新冠肺炎大流行期间远程医疗可用性的增加有关。然而，在黑人居民比例较高的县以及接受医疗补助和儿童健康保险计划的人中，机会差距仍然存在。这项研究的结果表明，尽管国家政策的变化可能会促进通过远程保健更多地获得精神卫生治疗，但在获得方面的差异仍然存在。尽管远程保健服务在新冠肺炎大流行期间迅速扩大，但国家政策与远程保健服务的可获得性之间的联系还没有得到充分的表征。调查4个州的政策与全美门诊精神卫生治疗机构的远程保健可用性之间的关系。这项队列研究衡量了心理健康治疗机构是否从2019年4月到2022年9月每个季度提供远程健康服务。样本包括不属于美国退伍军人事务部系统的门诊服务设施。从四个不同的来源确定了四项国家政策。对2023年1月的数据进行了分析。在每个季度，以下政策的执行情况按州分类：(1)私营保险公司之间远程保健服务的支付平价；(2)为医疗补助和儿童健康保险计划(CHIP)受益人授权提供纯音频远程保健服务；(3)参与《州际医疗执照契约》(IMLC)，允许精神病学家提供跨州远程保健服务；(4)参与《心理学跨管辖契约》(PSYPACT)，允许临床心理学家跨州提供远程保健服务。主要结果是心理健康治疗机构在每个研究年度(2019-2022年)的每个季度提供远程医疗服务的可能性。关于这些设施的信息是从基于药物滥用和精神健康服务管理局行为健康治疗服务定位器的精神健康和成瘾治疗跟踪储存库获得的。使用独立的多变量固定效应回归模型估计在政策实施前后提供远程医疗服务的概率的差异，调整了设施和设施所在县的特征。共有12个 828个精神健康治疗机构被纳入其中。总体而言，2022年9月，88.1%的设施提供远程医疗服务，而2019年4月，这一比例为39.4%。所有4项政策都与远程医疗可获得性增加相关：远程医疗服务的支付平价(调整后的优势比[AOR]，1.11；95%CI，1.03-1.19)，纯音频远程医疗服务的报销(AOR，1.73；95%CI，1.64-1.81)，IMLC参与(AOR，1.40，95%CI，1.24-1.59)，以及PSYPACT参与(AOR，1.21，95%CI，1.12-1.31)。在研究期间，接受医疗补助作为支付形式的设施提供远程医疗服务的几率较低(AOR，0.75；95%CI，0.65-0.86)，黑人居民比例较高的县(>；20%)的设施也是如此(AOR，0.58；95%CI，0.50-0.68)。农村地区的医疗机构提供远程医疗服务的几率较高(AOR为1.67；95%CI为1.48~1.88)。这项研究的结果表明，新冠肺炎大流行期间出台的4项州政策与全美精神卫生治疗机构远程医疗服务的显著扩大有关。尽管有这些政策，远程医疗服务在黑人居民比例较高的县以及接受医疗补助和CHIP的设施中提供的可能性较小。
This cohort study evaluates telehealth use and accessibility at US mental health treatment facilities before and during the COVID-19 pandemic. Were state-level policy changes from 2019 to 2022 associated with the expansion of telehealth services at mental health treatment facilities throughout the US? In this cohort study of 12 828 mental health treatment facilities, 4 state policies pertaining to payment parity, audio-only telehealth service reimbursement, and interstate licensure compacts were associated with increased telehealth availability during the COVID-19 pandemic in the US. However, access disparities persisted in counties with a higher proportion of Black residents and among Medicaid and Children's Health Insurance Program recipients. Findings of this study suggest that although changes to state policies may facilitate greater access to mental health treatment via telehealth, disparities in access persist. Although telehealth services expanded rapidly during the COVID-19 pandemic, the association between state policies and telehealth availability has been insufficiently characterized. To investigate the associations between 4 state policies and telehealth availability at outpatient mental health treatment facilities throughout the US. This cohort study measured whether mental health treatment facilities offered telehealth services each quarter from April 2019 through September 2022. The sample comprised facilities with outpatient services that were not part of the US Department of Veterans Affairs system. Four state policies were identified from 4 different sources. Data were analyzed in January 2023. For each quarter, implementation of the following policies was indexed by state: (1) payment parity for telehealth services among private insurers; (2) authorization of audio-only telehealth services for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries; (3) participation in the Interstate Medical Licensure Compact (IMLC), permitting psychiatrists to provide telehealth services across state lines; and (4) participation in the Psychology Interjurisdictional Compact (PSYPACT), permitting clinical psychologists to provide telehealth services across state lines. The primary outcome was the probability of a mental health treatment facility offering telehealth services in each quarter for each study year (2019-2022). Information on the facilities was obtained from the Mental Health and Addiction Treatment Tracking Repository based on the Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Service Locator. Separate multivariable fixed-effects regression models were used to estimate the difference in the probability of offering telehealth services after vs before policy implementation, adjusting for characteristics of the facility and county in which the facility was located. A total of 12 828 mental health treatment facilities were included. Overall, 88.1% of facilities offered telehealth services in September 2022 compared with 39.4% of facilities in April 2019. All 4 policies were associated with increased odds of telehealth availability: payment parity for telehealth services (adjusted odds ratio [AOR], 1.11; 95% CI, 1.03-1.19), reimbursement for audio-only telehealth services (AOR, 1.73; 95% CI, 1.64-1.81), IMLC participation (AOR, 1.40, 95% CI, 1.24-1.59), and PSYPACT participation (AOR, 1.21, 95% CI, 1.12-1.31). Facilities that accepted Medicaid as a form of payment had lower odds of offering telehealth services (AOR, 0.75; 95% CI, 0.65-0.86) over the study period, as did facilities in counties with a higher proportion (>20%) of Black residents (AOR, 0.58; 95% CI, 0.50-0.68). Facilities in rural counties had higher odds of offering telehealth services (AOR, 1.67; 95% CI, 1.48-1.88). Results of this study suggest that 4 state policies that were introduced during the COVID-19 pandemic were associated with marked expansion of telehealth availability for mental health care at mental health treatment facilities throughout the US. Despite these policies, telehealth services were less likely to be offered in counties with a greater proportion of Black residents and in facilities that accepted Medicaid and CHIP.