Table 2. Patient-Level Adjusted Differences in Mental Health Services and Changes in Outcomes by Practice Level of Telemedicine Use.
| Outcome | Practices with lowest telemedicine usea | Practices with middle telemedicine usea | Practices with highest telemedicine usea | Differential in changes by telemedicine use, No. (95% CI) | ||||
|---|---|---|---|---|---|---|---|---|
| Year 1, mean (SD) | Differential (95% CI) | Year 1, mean (SD) | Differential (95% CI) | Year 1, mean (SD) | Differential (95% CI) | Middle vs lowest | Highest vs lowest | |
| Total No. of mental health visits | 14.85 (22.53) | −0.60 (−1.20 to 0.01) | 11.52 (14.85) | 0.51 (0.25 to 0.77) | 12.72 (16.28) | 1.34 (1.07 to 1.60) | 1.11 (0.45 to 1.76) | 1.94 (1.28 to 2.59) |
| Visits delivered by mental health specialists | 13.97 (22.24) | −0.60 (−1.27 to 0.07) | 10.68 (14.50) | 0.34 (0.10 to 0.59) | 11.96 (15.97) | 1.27 (1.01 to 1.53) | 0.94 (0.23 to 1.66) | 1.87 (1.15 to 2.59) |
| Acute care encountersb | 1.61 (3.58) | −0.33 (−0.39 to −0.28) | 1.57 (3.43) | −0.30 (−0.33 to −0.26) | 1.45 (3.15) | −0.29 (−0.33 to −0.25) | 0.04 (−0.02 to 0.10) | 0.05 (−0.02 to 0.11) |
| Acute care encounters for mental illness | 0.30 (1.23) | −0.06 (−0.08 to −0.04) | 0.29 (1.10) | −0.04 (−0.05 to −0.02) | 0.26 (1.05) | −0.03 (−0.04 to −0.01) | 0.02 (0.0003 to 0.05) | 0.03 (0.01 to 0.06) |
| Months with antipsychotic or mood-stabilizing medication fills | 8.07 (4.51) | 0.01 (−0.05 to 0.07) | 8.13 (4.42) | −0.03 (−0.07 to 0.02) | 8.11 (4.45) | 0.01 (−0.04 to 0.05) | −0.04 (−0.11 to 0.04) | −0.01 (−0.08 to 0.07) |
| Minimum threshold of mental health visits, mean % (SD) | ||||||||
| ≥1 Visit every 3 mo | 59.9 (49.0) | −3.63 (−5.69 to −1.58) | 59.9 (49.0) | −2.32 (−3.97 to −0.67) | 63.1 (48.2) | −1.41 (−2.77 to −0.05) | 1.31 (−1.32 to 3.94) | 2.22 (−0.24 to 4.68) |
| ≥1 Visit every 6 mo | 87.4 (33.2) | −5.53 (−7.67 to −3.40) | 87.8 (32.8) | −2.28 (−4.21 to −0.34) | 89.2 (31.0) | −2.40 (−3.38 to −1.41) | 3.26 (0.38 to 6.13) | 3.14 (0.79 to 5.48) |
| No mental health visits in year 2, mean % (SD)c | 12.9 (33.5) | 4.34 (2.78 to 5.90) | 13.0 (33.6) | 3.07 (2.25 to 3.90) | 11.5 (31.9) | 2.49 (1.49 to 3.49) | −1.27 (−3.03 to 0.49) | −1.85 (−3.70 to −0.003) |
| Patient switched to new practice in year 2, mean % (SD)c | 15.2 (35.9) | −0.13 (−1.08 to 0.82) | 14.2 (34.9) | −0.80 (−1.57 to −0.04) | 12.7 (33.3) | −1.43 (−1.98 to −0.89) | −0.67 (−1.89 to 0.55) | −1.30 (−2.39 to −0.21) |
| Follow-up after discharge, mean % (SD) | ||||||||
| Within 7 d | 42.1 (49.4) | 0.73 (−3.27 to 4.73) | 40.3 (49.1) | 1.09 (−1.76 to 3.94) | 42.9 (49.5) | 0.66 (−2.36 to 3.68) | 0.36 (−4.55 to 5.27) | −0.07 (−5.08 to 4.94) |
| Within 30 d | 69.8 (45.9) | 1.12 (−3.25 to 5.48) | 71.9 (45.0) | −0.49 (−3.28 to 2.30) | 72.8 (44.5) | 0.39 (−2.71 to 3.49) | −1.61 (−6.79 to 3.57) | −0.73 (−6.09 to 4.64) |
| Mortality rate, mean % (SD)c,d | 2.9 (16.7) | 0.97 (0.66 to 1.28) | 2.8 (16.4) | 0.62 (0.38 to 0.85) | 2.6 (15.9) | 0.57 (0.35 to 0.79) | −0.35 (−0.73 to 0.03) | −0.34 (−0.73 to 0.04) |
Abbreviation: TMH, telemental health.
Practices were categorized based on the proportion of TMH visits relative to all mental health visits (TMH and in-person visits) provided during the first year of the pandemic (March 2020-February 2021) into 3 groups: lowest telemedicine use (0%-49% TMH visits), middle telemedicine use (50%-89% TMH visits), or highest telemedicine use (90%-100% TMH visits).
Hospitalization or emergency department visits.
These outcomes were only available in year 2 and represent year 2 differential changes between the pandemic and prepandemic cohorts. For these outcomes only, the values in the year 1 mean columns are year 2 means (SDs) from the prepandemic cohort.
Due to its low probability, mortality was modeled using logistic regression. All other outcomes used linear regression.