Dr. Jacqueline M. Ferguson
Credit: Stanford University
Mental health video visits have continued to increase over the past year, new study finds, even though telehealth visits stabilized around May 2021 and declined after the peak of the COVID-19 pandemic did.1
“this [Veteran Affairs] “This study provides an up-to-date timeline of changes in the use of in-person visits and telehealth since the beginning of the COVID-19 pandemic,” the researchers wrote. “A new equilibrium has emerged, with telephone-based care almost back to pre-pandemic levels, while video-based care now accounts for 11% to 12% of outpatient visits (up from pre-pandemic levels of 0.5%). 2300% increase).”
At the beginning of the COVID-19 pandemic, many people, including those on Medicare, turned to telemedicine to seek medical care.2 Prior to the pandemic, Medicare beneficiaries could not use telehealth services unless their location limited their access to in-person care. This has changed with the pandemic. Meanwhile, the Department of Health and Human Services has waived some telehealth restrictions for Medicare, making it easier for some individuals to get to appointments.2
The study was led by Dr. Jacqueline M. Ferguson of the Innovation Implementation Center at the Veterans Affairs Palo Alto Health System in Menlo Park, Calif., and was conducted from January 1, 2019 to August 2019. The purpose was to assess trends. 2023.1 The team evaluated outpatient visits conducted in person, by phone, and by video before, during, and after the pandemic. The federal government declared a public health emergency due to the novel coronavirus on March 11, 2020 before the pandemic, from March 11, 2020 to May 10, 2023, during the pandemic, and on May 11, 2023 after the pandemic. marked by the end of.
Participants were from the U.S. Department of Veterans Affairs health care system, and researchers identified 277,348,286 clinical outpatient visits through the Department of Veterans Affairs Corporate Data Warehouse. The database includes data from 9 million veterans enrolled in VA services, and approximately 5.4 million people used VA outpatient medical services in 2019.
Data included in the study were 91% male, 72% Caucasian, and 65% lived in an urban area. Medical visits were categorized by care service (primary care, mental health, subspecialty care) and modality (in-person, mental health, video).
The team observed that the Department of Veterans Affairs had 1.14 million primary care, subspecialty, or mental health visits each week, and 4.9 million visits each month. Visitor numbers began to decline at the start of the pandemic and did not stabilize until March 2021.
“Notably, this stabilization occurred around the time the vaccine became widely available, two years before the end of the federal COVID-19 public health emergency,” the researchers wrote. writing.
In-person primary care and mental health services have been replaced by telehealth. As in-person visits declined, telephone and video-based visits increased, with in-person visits decreasing from 81% in February 2020 to 23% in May 2020.
However, telephone and video-based care began to decline from a peak of 79.6% of total care in April 2020 to 36.7% in April 2023. This percentage was primarily due to a decrease in the number of video visits, as well as a decrease in telephone visits rather than video visits. He remained close to his peak at a level of 11%-13%.
The researchers noted that while people continue to use video visits for mental health, their use for primary care and specialty visits began to decline as the pandemic drew to a close. By August 2023, 34.5% of mental health visits, 3.7% of subspecialty visits, and 3.5% of primary care visits were conducted by video, and 20.3%, 34.8%, and 16.7%, respectively, were by phone.
Researchers say 55% of mental health care continues to be delivered via telehealth. This may be because mental health services are adapting to virtual platforms. Additionally, they found that while primary care and subspecialty telemedicine is “often limited by the need for in-person assessments” including physical exams, 10% of primary care and subspecialty care is delivered to telemedicine. He pointed out that he was switching.
“While these national trends can inform research and policy, they also obscure disparities in access and utilization of telehealth, and may help patients from older populations, rural individuals, and historically marginalized populations.” have a disproportionate impact on the population,” the researchers wrote. “Future research should consider evaluating the quality, safety, and health outcomes of telemedicine in this new equilibrium.”
References
- Ferguson JM, Ray CM, Van Kampen J, Zulman DM. The new balance of telehealth: The prevalence of in-person, video-based, and telephone-based care at the Veterans Health Administration, 2019-2023. Ann Intern Med. Published online on January 23, 2024. doi:10.7326/M23-2644
- Telemedicine in a pandemic—how has healthcare delivery changed in Medicaid and Medicare? U.S. Government Accountability Office. September 29, 2022. https://www.gao.gov/blog/telehealth-pandemic-how-has-it-changed-health-care-delivery-medicaid-and-medicare. Accessed January 23, 2024.
