A recently published study, “Use of Telemedicine and Quality of Care Among Medicare Enrollees With Serious Mental Illness,” was published in the JAMA Health Forum on October 27, 2023, and led by Andrew D. Wilcock. The research team aimed to assess the implications of telehealth use during the COVID-19 pandemic on the quality of care among Medicare beneficiaries diagnosed with serious mental illnesses (SMI), specifically Schizophrenia and Bipolar I Disorder. In particular, this sizeable study sought to compare practice changes with higher vs lower Medicare telehealth use. The study’s sample involved 120,050 participants from March 2019 to February 2021.
Methodological Strengths
Detailed Analysis. The study looked at various quality metrics beyond just the frequency of attendance for scheduled visits.
Temporal Comparison. The study also drew comparisons with data from a 2-year pre-pandemic period to isolate the effects of the pandemic and telemedicine utilization.
Large Sample Size. The extensive cohort bolsters the study’s statistical power and generalizability.
Key Findings: Medicare Telehealth Study
Although this study’s findings were extensive, these main points have been extracted for the reader’s convenience:
Research Design. The research used a multicohort study design and analyzed data from Medicare telehealth fee-for-service beneficiaries.
Participants were divided into three groups based on their healthcare providers’ telemedicine adoption rates during the first year of the pandemic: low use (0%-49%), medium use (50%-89%), and high use (90%-100%).
Multiple outcomes were examined, including the total number of mental health visits, medication adherence rates, and acute care utilization.
Increased Mental Health Visits. Patients receiving care at practices that predominantly switched to telemental health services showed a 13.0% increase in mental health visits compared to those in practices mainly utilizing in-person visits.
No Significant Change in Other Metrics. The study found no significant changes in medication adherence, emergency department use, hospitalizations, or mortality rates based on the level of Medicare telehealth utilization.
Implications
The findings published by the Wilcox research team highlight that while telehealth facilitated an increase in the frequency of mental health visits for individuals with SMI, it did not substantially alter other measures of healthcare quality, such as medication adherence and acute care usage. This study can be seen as yet another that validates the capability of telehealth to be comparable to in-person mental healthcare delivery for this vulnerable population across practices with higher vs. lower telehealth use.
Most notably, telehealth was shown to improve accessibility. Being the key benefit of telehealth (Maheu & Gordon, 2000; Maheu, Whitten & Allen, 2001) increased access to care at all stages in the trajectory of a disorder, from early to late stage, unlocks many doors for seriously mentally ill people and their families (Maheu et.al., 2004).
Also of note is that SMI includes several additional diagnostic categories, all of which have had empirical support for specified telehealth techniques. Some of these have been addressed by Telehealth.org in these brief summary articles: major depression, obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic stress (PTSD).
Medicare Telehealth Study Summary
The study under discussion presents an in-depth examination of the use and effectiveness of telehealth practices for SMI during the COVID-19 pandemic.