Telemedicine and Disparities in Mental Health Service Use Among Community-Dwelling Older Adults With Alzheimer Disease and Related Dementias.
Shubing Cai, Qiuyuan Qin, Peter Veazie and 1 others
PMID 38768645WHAT IT FOUND
Black and Hispanic older adults with dementia, and those in deprived communities, used mental health services less.
Early in the pandemic they had smaller increases in remote mental health visits, and the community deprivation gap widened later.
Key findings
01In-person mental health visits dropped to 8.4% in the second quarter of 2020 and recovered to 14.1% by the end of the study period, while remote mental health visits dropped from 8% to 4.7%.
02At the beginning of the pandemic, White older adults had a 5.05 percentage-point decrease in in-person mental health visits, while Black and Hispanic older adults had about a 3 percentage-point decrease and a 2 to 3 percentage-point smaller increase in remote mental health visits. Deprived communities had a 2.59 percentage-point smaller increase in remote mental health visits.
03Black and Hispanic older adults and those in deprived communities were less likely to use mental health services before the pandemic. Between 2020Q3 and 2021Q4, the racial gap narrowed from 2.68 to 2.19 percentage points and the ethnic gap from 3.49 to 3.07 percentage points, while the deprived-community gap widened from -0.62 to -1.24 percentage points.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only Medicare fee-for-service enrollees were included, not Medicare Advantage enrollees. Claims data could not show mental health condition severity or service quality. The study was observational, so it cannot prove that telemedicine caused any change in access. The early uncertain pandemic quarter was excluded. Only a limited study window was included, so later post-pandemic trends are unknown.
Declared interests
The authors declared no conflicts of interest. The paper notes NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not conclude that telemedicine closed access gaps. This is an observational claims study, and the deprivation-related gap in overall mental health service use widened while some remote-visit gaps narrowed.