Accepted for/Published in: JMIR Mental Health
Date Submitted: Mar 6, 2023
Date Accepted: Jul 28, 2023
Telehealth and In-Person Behavioral Health Services in Rural Communities Before and During the COVID-19 Pandemic: A Multi-site Study
ABSTRACT
Background:
The COVID-19 pandemic triggered widespread adjustments across the U.S. health care system. Many providers adopted telehealth for the first time or expanded their telehealth offerings. Telehealth use for mental health conditions and services showed a substantial increase due to acute public health emergency (PHE) behavioral health needs on top of longstanding gaps in access to behavioral health services. How health systems that were already providing tele-behavioral health services adjusted during this period has not been well documented, particularly in rural areas that suffer chronic shortages of behavioral health providers and services.
Objective:
This study investigates patient and treatment characteristic changes from before the COVID-19 PHE to during the PHE within both telehealth and in-person behavioral health services provided in 95 rural communities.
Methods:
This nonrandomized, prospective, multi-site, cohort study used chi-squared tests to compare changes from pre-PHE to PHE time periods within telehealth and in-person treatment cohorts. Patients were followed for three months after their initial visit. The 4,780 patients in the telehealth cohort and the 6,457 patients in the in-person cohort had an average of 3.5 encounters during this three-month period.
Results:
The telehealth cohort increased from 30% in the pre-PHE period to 35% in the PHE period in encounters involving anxiety, dissociative, and stress-related disorders, and the in-person cohort increased from 11% in the pre-PHE period to 18% in the PHE period in encounters involving substance use disorders. The telehealth cohort increased from 1% in the pre-PHE period to 11% in the PHE period in encounters involving treatment service codes for alcohol, drug, and medication assisted therapy; likewise, the in-person cohort increased from 0% in the pre-PHE period to 16% in the PHE period. From the pre-PHE to the PHE period, the telehealth cohort increased from 8% to 14% of encounters involving 60-minute psychotherapy, while the in-person cohort decreased from 12% to 4% of encounters involving group therapy.
Conclusions:
The COVID-19 pandemic challenged health service providers to adjust the way both telehealth and in-person behavioral therapy services were delivered.
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