A Veterans Health Administration (VHA) program; provides video-enabled tablets to veterans with mental disorders leads to improved access and continuity of care. A new study published online in Psychiatric Services in Advance finds that video-enabled tablets; can improve mental health care access for patients who experience barriers because of geographic, social, or health-related circumstances.
About a third of the about 9 million veterans enrolled in VHA live in rural or island areas; and many have transportation or financial challenges to getting care. In addition, veterans with mental disorders may avoid care because of stigma or privacy concerns. The VHA began distributing video-enabled tablets to veterans; with mental disorders and barriers to accessing care in 2016.
A retrospective matched cohort study was conducted; matching tablet recipients with diagnoses of mental disorders (N=728) to a comparison group (N=1,020) on the basis of sociodemographic characteristics; mental health utilization and diagnoses, and wireless coverage. A difference-in-differences approach was used to compare 6-month pre-post changes in number of psychotherapy; and medication management visits, continuity of psychotherapy based on VHA’s quality metric for mental health care continuity; missed opportunity rate, and probability of any and number of emergency department (ED) or urgent care visits.
However, the researchers, led by Josephine C. Jacobs, Ph.D. with the U.S. Department of Veterans Affairs Health Economics Resource Center in Menlo Park, California; looked at more than 700 tablet recipients and more than 1,000 individuals in a control group to evaluate the implementation of this initiative. The age distribution of the tablet recipients was similar to that of VHA users overall and the average age was 59.
But they looked at 6-month pre-post changes in number of psychotherapy and medication management visits, continuity of psychotherapy based on VHA’s quality metric, and the proportion of mental health appointments missed or canceled. The veterans who received the tablets had increased psychotherapy visits and medication management encounters compared to the matched control group.
Measure for psychotherapy
The tablet recipients were significantly more likely than control group participants to meet VHA’s continuity-of-care measure for psychotherapy (20.6% versus 2.6%). Those receiving a tablet also had a lower rate of missed or canceled appointments compared with the matched control group. The study also looked at the number of emergency department or urgent care visits and found no significant differences between the two groups.
No significant differences in ED or urgent care found. The authors conclude that “VA’s telehealth tablet initiative successfully improved access to mental health services for veterans with access barriers and may serve as a model for other large, integrated health care systems aiming to address access barriers.”