Telehealth Implementation, Treatment Attendance, and Socioeconomic Disparities in Treatment Utilization in a Community Mental Health Setting During the COVID-19 Pandemic: A Retrospective Analysis of Electronic Health Record Data.

Abstract

Background: Previous studies have found that the widespread implementation of telehealth for outpatient mental health treatment during the COVID-19 pandemic has been associated with reduced no-show rates and increases in total number of appointments. However, it is unclear to what degree this is due to increased accessibility provided by telehealth, rather than to increased consumer demand for services fueled by the pandemic-related exacerbation of mental health needs. To shed light on this question, the present analysis examined changes in attendance rates for outpatient, home-, and school-based programs at a community mental health center in southeastern Michigan. Disparities in treatment utilization associated with socioeconomic status were also examined.

Methods: Two-proportion z-tests were conducted to examine changes in attendance rates, and Pearson correlations were calculated using the median income level and attendance rate by zip code to examine disparities in utilization associated with socioeconomic status.

Results: The proportion of appointments kept after telehealth implementation was statistically significantly higher for all outpatient programs, but not for any home-based programs. Specifically, absolute increases in the proportion of appointments kept ranged from 0.05 to 0.18 for outpatient programs, representing relative increases of 9.2% to 30.2%. Furthermore, before telehealth implementation, there was a strong positive correlation between income and attendance rate for all outpatient programs (ranging from r = 0.50 to 0.56). After telehealth implementation, there were no longer any significant correlations.

Discussion: Results highlight the utility of telehealth in increasing treatment attendance and mitigating disparities in treatment utilization associated with socioeconomic status. These findings are highly relevant to ongoing discussions surrounding the long-term fate of evolving insurance and regulatory guidelines pertaining to telehealth.