Protocol: A mixed-methods study to evaluate implementation and outcomes of U.S. state telemental health policy expansion during the COVID-19 pandemic.

Background: Until the COVID-19 pandemic, it had not been possible to examine the effect of rapid policy changes surrounding telemental health on patient-reported mental health care access, costs, symptoms, and functioning. Sizable variation in telemental health use by patient race-ethnicity, age, and rurality, and in its adoption across healthcare settings, underscores the need to study equitable dissemination and implementation of high-quality telemental health services in the real world. This protocol describes an explanatory sequential mixed-methods study that aims to examine the effects of state telemental health policy expansion on patient-reported mental health outcomes, as well as the policy-to-practice pathway from the perspectives of state leaders, clinicians, and staff who care for underserved patients.

Patient Experiences With Group Teletherapy for the Treatment of Mental Illness: A Qualitative Study.

Objective: The authors sought to understand patient experiences with group teletherapy to inform improvements in service delivery.

Methods: From December 2022 to October 2023, semistructured interviews were conducted with 20 adults with depression or bipolar disorder who had received outpatient group teletherapy in the past 2 years. A rapid thematic analysis was conducted by using a matrix to identify patterns and synthesize data.

Impacts of Telehealth Adoption on the Quality of Care for Individuals With Serious Mental Illness: Retrospective Observational Analysis of Veterans Affairs Administrative Data.

Background: Telehealth implementation can be challenging for persons with serious mental illness (SMI), which may impact their quality of care and health outcomes. The literature on telehealth's impacts on SMI care outcomes is mixed, necessitating further investigation.

Objective: We examined the impacts of facility-level telehealth adoption on quality of care metrics over time among patients with SMI.

Perceptions of stimulant and buprenorphine diversion and strategies to address it.

There is ongoing policy debate on the prescribing of controlled substances such as buprenorphine and stimulants via telemedicine. The goal of federal and state policymakers is to ensure access to care while limiting diversion risk. However, there is little evidence on how clinicians view and address diversion and on telemedicine's role in diversion.

Access challenges for patients with limited English proficiency: a secret-shopper study of in-person and telehealth behavioral health services in California safety-net clinics.

The recent growth of telehealth may be impacting access to care for patients, including those with limited English proficiency (LEP). Using a secret-shopper design, simulated patients contacted 386 safety-net clinics in California in both Spanish and English from February-March 2023. Callers stated that they were new patients seeking medication for depression, and they documented time to an appointment and available visit modalities (telehealth and in-person).

Trends in Use of Telemedicine for Stimulant Initiation Among Children and Adults.

Objective: The authors sought to examine trends in stimulant initiation and follow-up care for attention-deficit hyperactivity disorder (ADHD) via telemedicine.

Methods: This retrospective longitudinal study used national, deidentified commercial health insurance outpatient claims among children (ages 2-17 years; N=535,629) and adults (ages 18-64 years; N=2,116,160) from January 2019 through April 2022. Regression analyses were used to examine risk for stimulant initiation, whether initiation occurred via telemedicine or in-person care, and receipt of a follow-up visit.

Use of Telemedicine and Quality of Care Among Medicare Enrollees With Serious Mental Illness.

Importance: During the COVID-19 pandemic, a large fraction of mental health care was provided via telemedicine. The implications of this shift in care for use of mental health service and quality of care have not been characterized.

Objective: To compare changes in care patterns and quality during the first year of the pandemic among Medicare beneficiaries with serious mental illness (schizophrenia or bipolar I disorder) cared for at practices with higher vs lower telemedicine use.

Choosing Or Losing In Behavioral Health: A Study Of Patients' Experiences Selecting Telehealth Versus In-Person Care.

It is not known how the growth of telehealth has affected patients' choice of visit modalities (telehealth versus in person). In 2023 we conducted a mixed-methods study that paired a nationally representative survey of 2,071 adults (including 571 who used behavioral health services) and semistructured interviews with twenty-six people with depression or bipolar disorder. We explored patients' experiences with visit modality selection and their agency in the decision.

Effects of Virtual Care and Same-Day Access to Integrated Care on Specialty Mental Health Engagement in the Veterans Health Administration.

Background: In the Veterans Health Administration (VA), Primary Care-Mental Health Integration (PC-MHI) clinics offer mental health services embedded in primary care, a strategy shown to reduce overall specialty mental health clinic burden while facilitating prompt referrals when indicated. Among newly initiated patients, same-day access to PC-MHI from primary care increases subsequent specialty mental health engagement. However, the impact of virtual care on the association between same-day access to PC-MHI and subsequent mental health engagement remains unclear.

Engaging Veterans With Serious Mental Illness in Primary Care.

Background: Veterans with serious mental illness (SMI) are at substantial risk for premature mortality. Engagement in primary care can mitigate these mortality risks. However, veterans with SMI often become disengaged from primary care.

Perspectives of Patients Receiving Telemedicine Services for Opioid Use Disorder Treatment: A Qualitative Analysis of User Experiences.

Objective: Telemedicine for opioid use disorder (tele-OUD) has the potential to increase access to medications for OUD (MOUD). Fully virtual tele-OUD services, in which all care is provided via telemedicine, are increasingly common, yet few studies document the experiences of patients who use such services. Understanding patient perspectives is one of multiple considerations to inform the regulation and reimbursement of tele-OUD services.

Association Between Telemedicine Use in Nonmetropolitan Counties and Quality of Care Received by Medicare Beneficiaries With Serious Mental Illness.

Importance: Access to specialty mental health care remains challenging for people with serious mental illnesses, such as schizophrenia and bipolar disorder. Whether expansion of telemedicine is associated with improved access and quality of care for these patients is unclear.

Objective: To assess whether greater telemedicine use in a nonmetropolitan county is associated with quality measures, including use of specialty mental health care and medication adherence.

Association Between Virtual Care Use and Same-Day Primary Care Access in VA Primary Care-Mental Health Integration.

Introduction: Same-day referrals from primary care to mental health increase subsequent mental health treatment engagement. VA Primary Care-Mental Health Integration (PC-MHI) clinics offer integrated mental health services embedded in primary care clinics, providing a key entry point to mental health care. Although telehealth use expanded rapidly after the onset of COVID-19, the impact of telehealth on same-day primary care access among new PC-MHI mental health patients is unknown.

Disruptions in Care for Medicare Beneficiaries With Severe Mental Illness During the COVID-19 Pandemic.

Importance: Little is known about changes in care for individuals with severe mental illness during the COVID-19 pandemic.

Objective: To examine changes in mental health care during the pandemic and the use of telemedicine in outpatient care among Medicare beneficiaries with severe mental illness.

Design, Setting, And Participants: This population-based cohort study included Medicare beneficiaries (age ≥18 years) diagnosed with schizophrenia and schizophrenia-related disorders or bipolar I disorder.

Appropriateness of Telemedicine Versus In-Person Care: A Qualitative Exploration of Psychiatrists' Decision Making.

Objective: With widespread adoption of telemedicine in response to the COVID-19 pandemic, psychiatrists must determine which visits are best conducted via telemedicine versus in person. Although some telepsychiatry guidelines and best practices have been developed, the literature has not described how psychiatrists make decisions about offering different care modalities. The authors explored how psychiatrists decide whether telemedicine is appropriate for a given patient.

Bridging the Acute-to-Outpatient Care Gap in Mental Health: Developing and Implementing a Mental Health Transition Process.

Background: A national Department of Veterans Affairs (VA) mental health (MH) quality metric tracks engagement in outpatient MH care after discharge from residential and inpatient settings, with recommendations for 2 or more visits 30 days postdischarge.

Local Problem: A gap in transitioning patients from residential to outpatient MH care was identified at this site.

Methods: A transition management process was developed and piloted, including a new MH Discharge Consult and an RN Transition Care Managers team.

Initiating Opioid Use Disorder Medication via Telemedicine During COVID-19: Implications for Proposed Reforms to the Ryan Haight Act.

Background: The Ryan Haight Act generally requires a clinician to conduct an in-person visit before prescribing an opioid use disorder (OUD) medication. This requirement has impeded use of telemedicine to expand OUD treatment, and many policymakers have called for its removal. During the COVID-19 pandemic, beginning March 16, 2020, the requirement was temporarily waived.

Use of telemedicine for opioid use disorder treatment - Perceptions and experiences of opioid use disorder clinicians.

Objective: To understand clinician use of and opinions about telemedicine for opioid use disorder (tele-OUD) during the COVID-19 pandemic.

Methods: An electronic national survey was administered in fall 2020 to 602 OUD clinicians recruited from WebMD/Medscape's online panel. The survey completion rate was 97.

Access to Care for Veterans With Serious Mental Illness During the COVID-19 Pandemic.

Objective: The authors examined access to care among persons with serious mental illness during the pandemic and disparities in use of virtual care among this population versus among individuals with other psychiatric diagnoses.

Methods: Data from the Veterans Health Administration were used to examine whether the number of visits for serious mental illness differed for January-September 2019 versus the same period in 2020. Mixed-effects regression analyses tested whether the post-COVID-19 rate of growth in virtual care differed for people with serious mental illnesses versus those with other diagnoses.

Suddenly Becoming a "Virtual Doctor": Experiences of Psychiatrists Transitioning to Telemedicine During the COVID-19 Pandemic.

Objective: In response to the COVID-19 pandemic, many psychiatrists have rapidly transitioned to telemedicine. This qualitative study sought to understand how this dramatic change in delivery has affected mental health care, including modes of telemedicine psychiatrists used, barriers encountered, and future plans. The aim was to inform the ongoing COVID-19 response and pass on lessons learned to psychiatrists who are starting to offer telemedicine.

Treatment of opioid use disorder during COVID-19: Experiences of clinicians transitioning to telemedicine.

Objective: The COVID-19 pandemic has transformed care delivery for patients with opioid use disorder (OUD); however, little is known about the experiences of front-line clinicians in the transition to telemedicine. This study described how, in the context of the early stages of the pandemic, clinicians used telemedicine for OUD in conjunction with in-person care, barriers encountered, and implications for quality of care.

Methods: In April 2020, we conducted semistructured interviews with clinicians waivered to prescribe buprenorphine.