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Temporal Trends in Telehealth Availability in Mental Health Treatment Settings: Differences in Growth by State Rurality, 2015–2020

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Abstract

We sought to investigate temporal trends in telehealth availability among outpatient mental health treatment facilities and differences in the pace of telehealth growth by state urbanicity and rurality. We used the National Mental Health Services Survey (2015–2020) to identify outpatient mental health treatment facilities in the US (N = 28,989 facilities; 2015 n = 5,018; 2020 n = 4,889). We used logistic regression to model telehealth, predicted by time, state rurality (1 to 10% rural, 10 to < 20%, 20 to < 30%, or \(\ge\) 30%), and their interaction, and adjusted for relevant covariates. We estimated the predicted probability of telehealth based on our model. We estimated effects with and without data from 2020 to assess whether the rapid and widespread adoption of telehealth during the COVID-19 pandemic changed the rural/urban trajectories of telehealth availability. We found that telehealth grew fastest in more urban states (year*rurality interaction p < 0.0001). Between 2015 and 2020, the predicted probability of telehealth in more urban states increased by 51 percentage points (from 9 to 61%), whereas telehealth in more rural states increased by 38 percentage points (from 23 to 61%). Predicted telehealth also varied widely by state, ranging from more than 75% of facilities (RI, OR) to below 20% (VT, KY). Health systems and new technological innovations must consider the unique challenges faced by urban populations and how best practices may be adapted to meet the growing urban demand. We framed our findings around the need for policies that minimize barriers to telehealth.

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Data Availability

The Nationa Mental Health Services Survey is available online for free for public use through the Substance Abuse and Mental Health Services Administration. A link to the data files and codebooks is below: https://www.datafiles.samhsa.gov/dataset/national-mental-health-services-survey-2020-n-mhss-2020-ds0001.

References

  1. Edlund M, Unutzer J, Curran G. Perceived need for alcohol, drug, and mental health treatment. Soc Psychiatry Psychiatr Epidemiol. 2006;41:480–7.

    Article  PubMed  Google Scholar 

  2. Green J, McLaughlin K, Fillbrunn M, et al. Barriers to mental health service use and predictors of treatment drop out: racial/ethnic variation in a population-based study. Administration and Policy in Mental Health and Mental Health Services Research. 2020;47:606–16.

    Article  PubMed  Google Scholar 

  3. Bolin J, Bellamy G, Ferdinand A, et al. Rural Health People 2020: new decade, same challenges. J Rural Health. 2015;31(3):326–33.

    Article  PubMed  Google Scholar 

  4. Hartley D. Rural health disparities, population health, and rural culture. Am J Public Health. 2004;94(10):1675–8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Health Resources and Services Administration. Designated Health Professional Shortage Areas statistics. First quarter of fiscal year 2023, designated HPSA quarterly summary. Rockville, MD. HRSA, Bureau of Health Workforce. 2023. https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport. Accessed 30 Aug 2023.

  6. United States Centers for Disease Control and Prevention. About Rural Health. U.S. Department of Health & Human Services. Updated May 9, 2023. Accessed 30 Aug 2023.

  7. Morales D, Barksdale C, Beckel-Micthener A. A call to action to address rural mental health disparities. Journal of Clinical and Translational Science. 2020;4(5):463–7.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Singh G, Siahpush M. Widening rural-urban disparities in life expectancy, U.S., 1969-2009. Am J Preven Med. 2014;46(2):e19–29.

    Article  Google Scholar 

  9. Cyr M, Etchin A, Guthrie B, Benneyan J. Access to specialty healthcare in urban versus rural US populations: a systematic literature review. BMC Health Serv Res. 2019;19(974):1–17.

    Google Scholar 

  10. Patel S, Huskamp H, Busch A, Megrotra A. Telemental health and US rural-urban differences in specialty mental health use, 2010–2017. Am J Public Health. 2020;110(9):1308–14.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cantor J, McBain R, Kofner A, Hanson R, Stein B, Yu H. Telehealth adoption by mental health and substance use disorder treatment facilities in the COVID-19 pandemic. Psychiatr Serv. 2021;73(4):411–7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bogue-Kawaii B, Williams N, MacNear K. Mental health care access and treatment utilization in African American communities: an integrative care framework. Ingenta Connect. 2017;13(2):11–29.

    Google Scholar 

  13. Myers C. Using telehealth to remediate rural mental health and healthcare disparities. Issues Ment Health Nurs. 2019;40(3):233–9.

    Article  PubMed  Google Scholar 

  14. Bulkes N, Davis K, Kay B, Riemann B. Comparing efficacy of telehealth to in-person mental health care in intensive-treatment-seeking adults. J Psychiatr Res. 2022;145:347–52.

    Article  PubMed  Google Scholar 

  15. Levinson C, Spoor S, Keshishian A, Pruitt A. Pilot outcomes from a multidisciplinary telehealth versus in-person intensive outpatient program for eating disorders during versus before the COVID-19 pandemic. Int J Eat Disord. 2021;54(9):1672–9.

    Article  PubMed  Google Scholar 

  16. Whaibeh E, Mahmoud H, Naal H. Telemental health in the context of a pandemic: the COVID-19 experience. Curr Treat Options Psych. 2020;7:198–202.

    Article  Google Scholar 

  17. Beschloss A, Van Ramshorst R, Bachireddy C, Chen C, Ostrovsky A. New coding modifier offers opportunity to investigate audio-only telehealth. Health affairs forefront blog. November 18, 2022. https://www.healthaffairsorg/content/forefront/new-coding-modifier-ffers-opportunity-investigate-audio-only-telehealth. Accessed 30 Aug 2023.

  18. Consolidated Appropriations Act, 2021. H.R. 133. 116th Congress (2019-2020). House foreign relations committee. Senate foreign relations committee. Public Law No. 116-260. Accessed 30 Aug 2023.

  19. Archambault J, Nastasi V. Rating the states on telehealth best practices: a toolkit for a pro-patient and provider landscape. Expanded February 10, 2022. The Reason Foundation Los Angeles, CA. https://www.reasonorg/wp-content/uploads/rating-states-on-telehealth-best-practicespdf. Accessed 30 Aug 2023.

  20. Neri A, Whitfield G, Umeakunne E, et al. Telehealth and public health practice in the United States - Before, during, and after the COVID-19 pandemic. Public Health Manag Pract. 2022;28(6):650–6.

    Article  Google Scholar 

  21. Chen J, Amaize A, Barath D. Evaluating telehealth adoption and related barriers among hospitals located in rural and urban areas. J Rural Health. 2020;37(4):801–11.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bagchi A, Damas K, Salazar de Noguera N, et al. Comfort with telehealth among residents of an underserved urban area. J Prim Care Commun Health. 2022;13:215013192211196.

    Article  Google Scholar 

  23. Auxier B, Anderson M. As schools close due to the coronavirus, some U.S. students face a digital ‘homework gap’. Pew Research Center. Research Topics - Coronavirus (COVID-19). March 16, 2020. Washington, D.C. 2020; Sourced from: https://www.pewresearch.org/fact-tank/2020/03/16/as-schools-close-due-to-the-coronavirus-some-u-s-students-face-a-digital-homework-gap/. Accessed 30 Aug 2023.

  24. Porter E. A rural-urban broadband divide, but not the one you think of. The New York Times. Business section. Published on June 1, 2021. Sourced from: https://www.nytimes.com/2021/06/01/business/rural-urban-broadband-biden.html. Accessed 30 Aug 2023.

  25. Rogers E. Diffusion of innovations. 5th ed. New York, NY: Free Press; 2003.

    Google Scholar 

  26. Boushey G. Policy diffusion dynamics in America. New York, NY: Cambridge University Press; 2010.

    Book  Google Scholar 

  27. Dearing J, Cox J. Diffusion of innovations theory, principles, and practice. Health Aff. 2018;37(2):183–90.

    Article  Google Scholar 

  28. Substance Abuse and Mental Health Services Administration. National Mental Health Services Survey (N-MHSS): 2020. Data on Mental Health Treatment Facilities Rockville, MD: Substance Abuse and Mental Health Services Administration; 2020.

    Google Scholar 

  29. United States Census Bureau. Urban and Rural. US Census Bureau Geography Program. Guidance for Geography Users. 2023. Sourced from: https://www.census.gov/programs-surveys/geography/guidance/geo-areas/urban-rural.html. Accessed 30 Aug 2023.

  30. SAS/STAT Inc. SAS Version 9.4. Cary, North Carolina, USA.

  31. University of California at Los Angeles Office of advanced research computing. Analyzing and visualizing interactions in SAS. UCLA OARC statistical methods and data analytics. section 7 - Logistic regression and comparing simple odds ratios and interpreting exponentiated interaction coefficients. 2023. Sourced from https://stats.oarc.ucla.edu/sas/seminars/analyzing-and-visualizing-interactions/ Accessed 30 Aug 2023.

  32. Health Resources and Services Administration (HRSA). Telehealth policy changes after the COVID-19 public health emergency. Information for providers. Update on the telehealth flexibilities during the COVID-19 public health emergency. 2023. Sourced from: https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/policy-changes-after-the-covid-19-public-health-emergency. Accessed 30 Aug 2023.

  33. Schofield M. Regulatory and legislative issues on telehealth. Nutr Clin Pract. 2021;36(4):729–38.

    Article  PubMed  Google Scholar 

  34. Brotman J, Kotloff R. Providing outpatient telehealth services in the United States: before and during coronavirus disease 2019. Educ Clin Pract: CHEST Rev. 2021;159(4):1548–58.

    CAS  Google Scholar 

  35. Chu R, Peters C, De Lew N, Sommers B. State Medicaid telehealth policies before and during the COVID-19 public health emergency. US Department of Health and Human Services. Office of Health Policy. Issue Brief, July 2021, No. HP-2021–17. 2021. Sourced from: https://aspe.hhs.gov/sites/default/files/documents/eb9e147935a2663441a9488e36eea6cb/medicaid-telehealth-brief.pdf. Accessed 30 Aug 2023.

  36. Shaver J. The state of telehealth before and after the COVID-19 pandemic. Prim Care. 2022;49(4):517–30.

    Article  PubMed  PubMed Central  Google Scholar 

  37. National Academies of Sciences, Engineering and Medicine. Communities in Action: Pathways to health equity. The state of health disparities in the United States. NASEM Board on population health and public health practice, committee on community-based solutions to promote heatlh equity in the United States. National Academies Press. 2017. Sourced from: https://www.ncbi.nlm.nih.gov/books/NBK425844/. Accessed 30 Aug 2023.

  38. Jensen E, Kennel T. Who was underconted, overcounted in the 2020 census? Detailed coverage estimates for the 2020 census released today. United States Census Bureau. March 10, 2022. Sourced from: https://www.census.gov/library/stories/2022/03/who-was-undercounted-overcounted-in-2020-census.html. Accessed 30 Aug 2023.

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Acknowledgements

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of award U3GRH40001 to the Rural Telehealth Research Center. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS, or the U.S. government. For more information please visit HRSA.gov.

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Authors and Affiliations

  1. Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    George Pro & Broome E. E. Montgomery

  2. Fay W. Boozman College of Public Health, Southern Public Health and Criminal Justice Research Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    George Pro & Broome E. E. Montgomery

  3. Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Brian Fairman

  4. Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Jure Baloh

  5. Department of Internal Medicine, College of Medicine, Community Health and Research, University of Arkansas for Medical Sciences, Fayetteville, AR, USA

    Don Willis

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Correspondence to George Pro.

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Pro, G., Fairman, B., Baloh, J. et al. Temporal Trends in Telehealth Availability in Mental Health Treatment Settings: Differences in Growth by State Rurality, 2015–2020. J Urban Health 100, 1149–1158 (2023). https://doi.org/10.1007/s11524-023-00795-y

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