Telepsychiatry adoption across hospitals in the United States: a cross-sectional study

Zhong Li,Xiaoming Li,Peiyin Hung,Sayward E Harrison

doi:10.1186/s12888-021-03180-8

Abstract

BackgroundAccess to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. When face-to-face follow-up is unavailable or undesirable, telepsychiatry becomes a promising alternative. This study aimed to investigate hospital- and county-level characteristics associated with telepsychiatry adoption.MethodsCross-sectional national data of 3475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption.ResultsAbout one-sixth (548 [15.8%]) of hospitals reported having telepsychiatry with a wide variation across states. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%). Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5 to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (− 6.9% [− 11.7% to − 2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (− 6.6% [− 12.7% to − 0.5%]) were less likely to have telepsychiatry.ConclusionsPrior to the Covid-19 pandemic, telepsychiatry adoption in US hospitals was low with substantial variations by urban and rural status and by state in 2017. This raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.

Highlights

Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care
Hospitals in affluent counties were more likely to adopt telepsychiatry compared with hospitals in less affluent counties
Hospitals in counties designated as mental health professional shortage areas, with smaller number of psychiatrists, reported lower levels of telepsychiatry adoption than their counterparts

Summary

Introduction

Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. Over 46 million Americans experienced a mental illness [1]; less than half (42.9%) of these individuals received mental health services in a 12-month window, partially due to stigma and limited access to care [1]. Millions of emergency department (ED) visits in the United States (US) involve mental illness and substance use disorders [2]. In 2016, 7.7 million hospitalizations, accounting for 21.7% of national hospital stays, were attributable to mental and substance use disorders [6]. Linkage to and continuity of mental health care is a challenge, with persistent high suicide rates for mental health patients following hospital discharge [7]

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