Telehealth Boosted Visits, Follow-Ups For Patients With Severe Mental Illness

A study published in JAMA Network Open found that increased telehealth use in rural communities positively impacted access to healthcare services for Medicare beneficiaries with severe mental illnesses.

Historically, people battling mental health conditions such as schizophrenia and bipolar disorder struggle to obtain necessary care, according to researchers. However, the expansion of telehealth services and access to technology in recent years has provided new methods of treating patients.

The study consisted of data from Medicare beneficiaries in 2,916 rural counties between Jan. 1, 2010, and Dec. 31, 2018. Patients included in the study had received a prior diagnosis of schizophrenia or bipolar I disorder.

Researchers collected data on telemental health use rates and hospitalization levels. Between 2010 and 2018, the portion of counties that had high telemental health service use increased from 2 percent to 17 percent. Researchers also reported that in 2018, high telemental health use counties had 1.08 telemental visits per patient.

Patients residing in high telehealth use counties were 1.2 percentage points more likely to participate in a minimum number of specialty mental health service visits and had a 13.7 percentage points higher likelihood of outpatient follow-up within seven days of hospitalization, compared to those in counties with no telemental healthcare.

But patients in high telehealth use counties also had a greater chance of hospitalization within a year.

Further, medication adherence was not positively affected by increases in telemental health service use.

Based on this data, researchers concluded that the increase of telemental health visits resulted in increased visits between patients and mental health professionals and boosted the chances of a follow-up after hospitalization, but did not improve medication adherence or lower hospitalizations. 

"Our initial hypothesis assumed that use of telemental health visits would be additive to in-person care and therefore be a factor in more frequent contact with specialty mental health care professionals and, in turn, better medication adherence and fewer acute crises resulting in ED visits or hospitalizations," they wrote. "Our results do not support this hypothesis. We observed increases in patients receiving minimum levels of visits and follow-up care but did not observe better medication adherence or fewer acute crises."

Researchers also observed limitations related a lack of evidence of what may have caused an increase in telehealth use, and no data on visits conducted by professional counselors. Also, regarding those eligible for Medicaid, there was a connection between greater telemental service use and increased medication adherence.

Recent data has also shown steady telehealth service use among Medicare beneficiaries, alongside efforts to expand Medicare coverage.

A report from June 2022 showed that telehealth served as a substitute for in-person care in 2021 among Medicare beneficiaries, helping maintain costs and avoiding a spike in the total number of patient visits.

An omnibus spending bill passed in March included provisions for telehealth extensions for Medicare patients. Specifically, it allows beneficiaries to receive virtual care regardless of location, along with access to physical therapists, occupational therapists, speech pathologists, and audiologists.