Telemental Health and US Rural-Urban Differences in Specialty Mental Health Use, 2010-2017

• Published in: American journal of public health (1971) Vol. 110; no. 9; pp. 1308 - 1314
• Main Authors: Patel, Sadiq Y, Huskamp, Haiden A, Busch, Alisa B, Mehrotra, Ateev
• Format: Journal Article
• Language: English
• Published: United States American Public Health Association 01.09.2020
• Subjects: Access to Care; Adult; Aged; Aged, 80 and over; AJPH Rural Health; Area codes; Beneficiaries; Bipolar disorder; Bipolar Disorder - therapy; Calendars; Female; Government programs; Health care; Health Care Facilities/Services; Health Service Delivery; Humans; Male; Medicare; Medicare - statistics & numerical data; Mental disorders; Mental Health; Mental health care; Middle Aged; Other Health Service Delivery; Patients; Public health; Rural areas; Rural Health; Rural Population - statistics & numerical data; Rural urban differences; Schizophrenia; Schizophrenia - therapy; Substance abuse treatment; Telemedicine; Telemedicine - trends; Trends; United States; Urban areas; Urban Population - statistics & numerical data; United States; United States > US
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/ajph.2020.305657

To examine whether growing use of telemental health (TMH) has reduced the rural-urban gap in specialty mental health care use in the United States. Using 2010-2017 Medicare data, we analyzed trends in the rural-urban difference in rates of specialty visits (in-person and TMH). Among rural beneficiaries diagnosed with schizophrenia or bipolar disorder, TMH use grew by 425% over the 8 years and, in higher-use rural areas, accounted for one quarter of all specialty mental health visits in 2017. Among patients with schizophrenia or bipolar disorder, TMH visits differentially grew in rural areas by 0.14 visits from 2010 to 2017. This growth partially offset the 0.42-visit differential decline in in-person visits in rural areas. In net, the gap between rural and urban patients in specialty visits was larger by 2017. TMH has improved access to specialty care in rural areas, particularly for individuals diagnosed with schizophrenia or bipolar disorder. While growth in TMH use has been insufficient to eliminate the overall rural-urban difference in specialty care use, this difference may have been larger if not for TMH. Targeted policy to extend TMH to underserved areas may help offset declines in in-person specialty care.