Skip to main content

Abstract

Objective:

In 2016, the Veterans Health Administration (VHA) began distributing video-enabled tablets to veterans with access barriers. This study evaluated the implementation of this initiative for veterans with mental health conditions, including the impact of tablet receipt on access to and continuity of mental health care, missed opportunities for care, and use of urgent care.

Methods:

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 (i.e., the proportion of mental health appointments that were missed or canceled), and probability of any and number of emergency department (ED) or urgent care visits.

Results:

Compared with the matched control group, tablet recipients experienced an increase of 1.94 (p<0.001) psychotherapy encounters, an increase of 1.05 (p<0.001) medication management visits, an 18.54 percentage point (p<0.001) increase in their likelihood of receiving recommended mental health care necessary for continuity of care, and a 20.24 percentage point (p<.001) decrease in their missed opportunity rate in the 6-month period following receipt of tablets (or the index date for the matched sample). No significant differences in ED or urgent care use were found.

Conclusions:

Distributing video-enabled tablets to veterans with mental health conditions appeared to improve access to and continuity of mental health services while also improving clinical efficiency by decreasing missed opportunities for care.

Formats available

You can view the full content in the following formats:

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 976 - 982
PubMed: 31378193

History

Received: 21 February 2019
Revision received: 23 May 2019
Revision received: 13 June 2019
Accepted: 17 June 2019
Published online: 5 August 2019
Published in print: November 01, 2019

Keywords

  1. Veterans issues
  2. Research/service delivery
  3. Tele–mental health
  4. access
  5. Continuity of care
  6. Rural health

Authors

Details

Josephine C. Jacobs, Ph.D [email protected]
U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling).
Daniel M. Blonigen, Ph.D.
U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling).
Rachel Kimerling, Ph.D.
U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling).
Cindie Slightam, M.P.H.
U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling).
Amy J. Gregory, B.A.
U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling).
Tolessa Gurmessa, M.D., M.S.
U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling).
Donna M. Zulman, M.D., M.S.
U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling).

Notes

Send correspondence to Dr. Jacobs ([email protected]).

Funding Information

Veterans Health Administration: Office of Rural Health Enterprise Wide Initiative, eHealth Partnered Evaluation Initiative
This work was supported by VA’s Office of Rural Health Enterprise Wide Initiative and the eHealth Partnered Evaluation Initiative (Quality Enhancement Research Initiative, Timothy Hogan, Ph.D., principal investigator).

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard

View Options

View options

PDF/EPUB

View PDF/EPUB

Full Text

View Full Text

Get Access

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login
Purchase Options

Purchase this article to access the full text.

PPV Articles - Psychiatric Services

PPV Articles - Psychiatric Services

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Media

Figures

Other

Tables

Share

Share

Share article link

Share