Telehealth Services Research Articles

Effect of telemental health adoption on mental health services utilization in federally qualified health centers.

Mental health issues disproportionately affect rural and low-income populations, where access to prevention and treatment is limited. Implementing telemental health services (TMHS) in Federally Qualified Health Centers (FQHCs) could improve accessibility to mental healthcare. This study assessed the effect of TMHS on mental health services utilization in FQHCs, comparing centers with and without TMHS and examined differences in TMHS effect between FQHCs that adopted TMHS before and during the pandemic. The study utilized FQHC-level data from Uniform Data Systems annual performance reports (N = 9540 FQHC-year) and county-level demographic, health status, and provider characteristic data from 2016 to 2022. A two-way fixed effects model was applied to examine the effect of TMHS on mental health visit rates, supplemented by the Sun and Abraham difference-in-differences estimator. The analysis included both pre-COVID and during-COVID TMHS adopters. FQHCs offering TMHS showed 1.04 times increase in overall mental health visit rates compared to those without TMHS. Centers serving higher proportions of Medicaid-insured (1.07 times) and low-income (below 200% FPL; 1.05 times) populations showed even higher visit rates. During-COVID TMHS adopters showed a significant increase (1.05 times), particularly in urban areas, whereas rural adopters did not see significant changes. FQHCs offering TMHS showed increased mental health visit rates, especially among low-income and Medicaid-insured populations. FQHCs that adopted TMHS during the pandemic experienced a marked rise in mental health visits, but rural-urban disparities persist, highlighting the ongoing challenges in expanding access to mental healthcare in rural settings.

Characterizing Telehealth Barriers and Preferences to Promote Acceptable Implementation Strategies in Central Uganda: Multilevel Formative Evaluation.

Telehealth approaches can address health care access barriers and improve care delivery in resource-limited settings around the globe. Yet, telehealth adoption in Africa has been limited, due in part to an insufficient understanding of effective strategies for implementation. This study aimed to conduct a multi-level formative evaluation identifying barriers and facilitators for implementing telehealth among health service providers and patients in Central Uganda. We collected surveys characterizing telehealth perceptions, barriers, and preferences from health care providers and patients seeking primary care in the Central Region of Uganda from January 2022 to July 2022. Survey development was informed by the technology acceptance model and evaluated predictors of technology acceptance (ie, perceived usefulness, ease of use, and attitudes). We used descriptive statistics to characterize telehealth perceptions and examined differences according to provider and patient characteristics using Student t tests. Nearly 79% (n=48) of 61 providers surveyed had used telehealth, and perceptions were generally favorable. While 93.4% (n=57) reported that telehealth adds value to clinical practice, less than half (n=30, 49.2%) felt telehealth was more efficient than in-person visits. Provider-reported barriers to telehealth included technology challenges for the patient (34/132, 26%), low patient engagement (25/132, 19%), and lack of implementation support (24/132, 18%). Telehealth use was lower among the 91 surveyed patients, with only 19.8% (n=18) having used telehealth. Although 89% (n=81) of patients reported saving time with telehealth approaches, 33.3% (n=30) of patients reported that telehealth made them feel uncomfortable, and 43.8% (n=39) reported concerns about confidentiality. Over 72% (n=66) of patients who had used telehealth previously reported satisfaction with the telehealth services they received. Several differences in perceptions of telehealth according to patient's self-reported health status were observed. Perceptions of telehealth were generally favorable, although higher among providers than patients. Barriers impeding telehealth use include technology challenges and the lack of infrastructure and implementation support. Findings from this study can inform the implementation of acceptable telehealth approaches to address disparities propagated by health care access barriers in Sub-Saharan Africa.

Increasing Access Through Integration: Behavioral Health Services and Beyond.

An academic health center (AHC) that provides primary care to an urban, underresourced population recognized the need for an integrated model of care to address behavioral health needs. The Ambulatory Integration of the Medical and Social (AIMS) Collaborative Care Model's five pillars provided the framework and enhanced outcomes through tailored initiatives at the AHC, expanding to onsite satellite locations in senior subsidized housing, and through telehealth services. The results showed increased access to behavioral health care and improved depression and anxiety symptoms. (Am J Public Health. Published online ahead of print January 23, 2025:e1-e5. https://doi.org/10.2105/AJPH.2024.307939).

Hybrid Neural Network Models to Estimate Vital Signs from Facial Videos

Introduction: Remote health monitoring plays a crucial role in telehealth services and the effective management of patients, which can be enhanced by vital sign prediction from facial videos. Facial videos are easily captured through various imaging devices like phone cameras, webcams, or surveillance systems. Methods: This study introduces a hybrid deep learning model aimed at estimating heart rate (HR), blood oxygen saturation level (SpO2), and blood pressure (BP) from facial videos. The hybrid model integrates convolutional neural network (CNN), convolutional long short-term memory (convLSTM), and video vision transformer (ViViT) architectures to ensure comprehensive analysis. Given the temporal variability of HR and BP, emphasis is placed on temporal resolution during feature extraction. The CNN processes video frames one by one while convLSTM and ViViT handle sequences of frames. These high-resolution temporal features are fused to predict HR, BP, and SpO2, capturing their dynamic variations effectively. Results: The dataset encompasses 891 subjects of diverse races and ages, and preprocessing includes facial detection and data normalization. Experimental results demonstrate high accuracies in predicting HR, SpO2, and BP using the proposed hybrid models. Discussion: Facial images can be easily captured using smartphones, which offers an economical and convenient solution for vital sign monitoring, particularly beneficial for elderly individuals or during outbreaks of contagious diseases like COVID-19. The proposed models were only validated on one dataset. However, the dataset (size, representation, diversity, balance, and processing) plays an important role in any data-driven models including ours. Conclusions: Through experiments, we observed the hybrid model’s efficacy in predicting vital signs such as HR, SpO2, SBP, and DBP, along with demographic variables like sex and age. There is potential for extending the hybrid model to estimate additional vital signs such as body temperature and respiration rate.

Providers’ understanding of patient experiences and disparities navigating telehealth services amid the COVID-19 pandemic

Providers’ understanding of patient experiences and disparities navigating telehealth services amid the COVID-19 pandemic

Federally qualified health center patients’ experiences with remote patient monitoring as part of telehealth services for self-measured blood pressure monitoring

BackgroundRemote patient monitoring (RPM) for hypertension management has become increasingly popular, demonstrating benefits for both clinics and patients. However, patient engagement in self-measured blood pressure (SMBP) monitoring remains low despite healthcare providers’ efforts. This study aimed to assess adherence and acceptance of RPM for SMBP among Texas Federally Qualified Health Center patients.MethodsParticipants enrolled in the SMBP monitoring program were recruited at three health centers. Data was collected from patient health records, and a questionnaire assessed hypertension self-management, technology acceptance, intentions, and attitudes toward SMBP. Thematic analysis was conducted for open-ended responses that followed each item, and multivariate linear regression assessed associations between psychosocial factors and SMBP use.ResultsThe sample (n = 47) was 64% female, 89% Hispanic/Latino, and 75% uninsured. Participants used RPM for SMBP an average of 46 days and 72 times within the first 120 days (~ 4 months). Age and behavioral intention were significantly positively associated with more days of SMBP use. Three themes emerged from open-ended data: perceived ease of learning and using mobile patient portal for SMBP, perceived benefits of using mobile patient portal for SMBP, and intentions to continue using the mobile patient portal for SMBP.ConclusionsParticipants found RPM for SMBP acceptable and easy to use. Use varied over time, with intention to use RPM for SMBP and older age linked to more days of use. RPM can enhance patient experience by providing additional information to the provider, prompting self-management discussions, and empowering patients to better control their BP.

Website as a Marketplace for Teleradiology/Telemedicine Solutions

The healthcare industry is rapidly evolving with advancements in technology, especially in telemedicine and teleradiology. These fields enable remote diagnosis and consultation, improving access to healthcare services globally. In this context the main and the primary objective of this project is to create a comprehensive, user-friendly web application that serves as a centralized marketplace for healthcare providers and vendors of teleradiology and telemedicine solutions. The platform will facilitate the buying, selling, and leasing of telemedicine equipment, software, and services, thereby enhancing the efficiency and reach of telehealth services.

Examining the affordable connectivity program and telehealth use: a pilot survey of the affordable connectivity program, telehealth, video and audio visits in a racially diverse, lower-income population

The Affordable Connectivity Program (ACP) aimed to narrow the digital divide by providing discounted internet services for millions of low-income households during the COVID-19 pandemic. This study examined associations between enrollment in the ACP and Telehealth visits in a racially diverse low-income population. Data were obtained via a cross-sectional survey of 213 respondents. Three multivariable regression models examined associations between ACP and three dependent variables, separately: (i) Used telehealth in the past 12 months, (ii) Had 1 or more video visits/consults in the past 12 months, and (iii) Had 1 or more telephone visits/consults in the past 12 months. 41% of survey respondents identified as non-Hispanic Black individuals, 33% as non-Hispanic White individuals, and 22% as Hispanic individuals. 69% reported a pre-tax annual household income of less than $35,000. Only 2 of 10 respondents had heard of ACP and were enrolled, while approximately 4 in 10 had never heard of it. Respondent knowledge/enrollment in the ACP was not significantly associated with telehealth, video consult, or telephone usage. Other demographic characteristics including race, income, educational attainment, and biological sex were significantly associated with telehealth, video, and telephone consults. We observed no association between ACP and telehealth use. While this finding is concerning, it offers an opportunity to reflect on potential reasons for ACP adoption gaps, such as digital literacy, device availability, and potential misconceptions about telehealth services.

"They Make It So Hard on You": How Rurality Shapes Veterans' Health Experiences When Managing Gulf War Illness.

Gulf War illness (GWI) is characterized by multiple, persistent symptoms (e.g., fatigue, musculoskeletal pain, concentration problems, and gastrointestinal disorders) across more than one body system that are severe enough to interfere with daily functioning. For Veterans in rural areas, the confluence of geographic barriers and GWI may create unique challenges when navigating health care, given the range of specialty care needed to support GWI. However, little is known about how rural Veterans manage their GWI symptoms and navigate health care systems. To examine how Veterans with GWI perceive rurality to influence their health care experiences. A cross-sectional qualitative study utilizing Health Experiences Research methodology. Veterans with GWI, who served in the active-duty US military, National Guard, or Reserves during the 1990-1991 Gulf War (GW) and who connected rurality to their health care experiences during interviews. Secondary qualitative analysis and inductive thematic analysis of semi-structured interviews, conducted between November 2018 and August 2021, with Veterans about their military and health experiences over time. Fifteen (n = 15) Veterans with GWI connected rurality to their health care experiences and quality of life. Three themes emerged from their interviews: (1) GWI and rural residence amplified problems with care coordination; (2) Managing GWI made distance especially burdensome; and (3) Rural contexts facilitated wellness and support, while creating barriers to accessing care. Our findings suggest that rurality intersects with GWI management in ways that compound barriers to health care access for Veterans. VA can address time and distance barriers by continuing to expand specialty telehealth services and telehealth training for providers and patients. VA could also incorporate recommendations from the VA/DoD clinical practice guidelines into point-of-care decision support to enhance recognition of GWI and improve consistency of treatment, which may contribute to trust-building among GW Veterans.

Health Care Facility Characteristics Associated With Providing Telehealth HIV Care Services During the COVID-19 Pandemic.

Objectives. To describe provision of HIV telehealth services during the COVID-19 pandemic using data from the Centers for Disease Control and Prevention (CDC) Medical Monitoring Project Facility Survey for the Ending the HIV Epidemic in the United States initiative, which aims to achieve an at least 90% reduction in new HIV infections by 2030 and highlights telehealth as an important strategy. Methods. During 2021, we surveyed 1023 facilities providing HIV care to a nationally representative sample of US adults with diagnosed HIV, of which 45% responded. We calculated weighted percentages with 95% confidence intervals comparing the characteristics of facilities providing telehealth services. Results. Overall, 83.4% of facilities provided HIV care telehealth services by the facility's own providers (82.0%) or by outside providers through remote conferencing (27.0%). Gaps in coverage were identified in smaller facilities and in facilities in rural and primary care health professional shortage areas. Conclusions. Although most HIV care facilities provided telehealth services during the COVID-19 pandemic, gaps were identified, which must be addressed to meet Ending the HIV Epidemic in the United States goals and better prepare for future health emergencies. (Am J Public Health. Published online ahead of print January 16, 2025:e1-e5. https://doi.org/10.2105/AJPH.2024.307908).

FACTORSINFLUENCINGEFFECTIVETELEHEALTHMANAGEMENT: PERSPECTIVES OF QUALITY COMPETENCY AND ORGANIZATIONAL CHANGE

This study investigates key factors influencing effective telehealth management in healthcare organizations in Saudi Arabia, particularly within primary health centers in Riyadh Saudi Arabia. Present study focuses on five primary areas: technology infrastructure, provider training and competency,patientengagement,regulatorycomplianceandqualityassurance,andorganizational culture and change management. A comprehensive survey questionnaire was conducted among healthcare staff, including directors, physicians, head nurses, and administrative personnel, to assess these factors' impact on telehealth effectiveness. SPSS was utilized for data analysis. Analysis of data revealed significant positive relationships between all suggested constructs which leads consequently to effective telehealth management. Specifically, technology infrastructure and organizational culture emerged as the strongest predictors. Further, findings emphasize the necessity of investing in robust technology systems, enhancingprovidertraining,,ensuringregulatorycompliance,promotingpatientengagement,and fostering a supportive organizational culture for the successful implementation of telehealth services. Study further provides practical implications for healthcare organizations and policymakers, offeringinsightsintooptimizingtelehealthservicestoimprovehealthcaredeliveryinSaudiArabia.

Trauma-focused evidence-based psychotherapy for post-traumatic stress disorder delivered via video telehealth in the Veterans Health Administration.

Trauma-focused evidence-based psychotherapy (EBP) is the recommended treatment for post-traumatic stress disorder (PTSD). During and after the COVID-19 pandemic, veterans began to initiate general mental health services delivered via video telehealth at high rates. Our goal in the current project was to describe the percentage as well as the demographic, military, and clinical characteristics of veterans receiving PTSD EBPs via video telehealth versus in-person. Using data from the VA electronic health record, we identified a national cohort of all-era veterans who received individual PTSD EBP between April 2022 and April 2023 (n = 24,447). We used multivariable hierarchical Bayesian logistic regression to model the probability of receiving at least 50% of their EBP care via video telehealth. In our sample, 74.4% of veterans who received PTSD EBP used video telehealth for at least one EBP session and 66.8% of veterans received at least half of their EBP sessions by video telehealth. Female veterans, younger veterans, and veterans with fewer mental health comorbidities were more likely to have received their PTSD EBP via video telehealth. Additional strong interaction effects for Black female veterans, Hispanic female veterans, female officer veterans, and Black officer veterans. Video telehealth delivery of PTSD EBPs was more common than in-person delivery of PTSD EBPs. Consistent with underlying trends in telehealth services, female veterans, and particularly female, racial/ethnic minority veterans were more likely to receive PTSD EBP via video telehealth. Future research designed to contextualize the observed differences in video telehealth delivery of PTSD EBPs should consider the role of social determinants of health.

Impact of COVID-19 on Substance Use Disorder Treatment: Examining the Influence of In-Person and Telehealth Intervention on Outcomes Using Real-World Data.

Background: The COVID-19 health crisis challenged healthcare systems around the world, leading to restrictions in access to face-to-face healthcare services, and forcing rapid adaptation to telehealth services. At present, there is a gap in the functioning of this adaptation in drug-dependence centres. The present study analyses, over four years, care indicators on the care modality (face-to-face vs. hybrid), the patient profile and the impact on retention in treatment. Methods: Retrospective observational study with data collected between 14 March 2019 and 21 June 2023. The electronic health records of 44,930 patients were analysed according to different moments and selected based on the different health measures imposed by the COVID-19 pandemic. Patients were classified according to whether they received an in-person or hybrid intervention. Bivariate statistics and logistic regression analysis were applied. Results: The trend over time shows an increase in the number of patients seen in addiction centres. However, no notable changes within the in-person care modality and a modest increase in telehealth services are observed. Telehealth is primarily used among patients with opiate addiction, as well as with those with comorbid mental disorders. Logistic regression analysis shows that patients in a hybrid modality are more likely to remain in treatment. Conclusions: Results show that hybrid care is associated with higher patient retention rates. Despite this, different profiles are mostly treated with in-person interventions rather than hybrid modalities. Future studies should explore how to generalise personalised hybrid care among SUD patients considering factors such as patients' educational level, employment status or accessibility to mental health services.

Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research.

Globally, 10% of pregnant women and 13% of postpartum women experience mental disorders. In Bangladesh, nearly 50% of mothers face common mental disorders, but mental health services and trained professionals to serve their needs are scarce. To address this, the government of Bangladesh's Non-Communicable Disease Control program initiated "Wellbeing Centers," telemental health services in selected public hospitals. This study examines implementation outcomes, including adoption, accessibility, acceptability, feasibility, usefulness, need, experience, perception, and expectations of the Wellbeing Centers, with a focus on antepartum and postpartum women. Between January 2023 and August 2024, we interviewed 911 antepartum and postpartum women receiving mental health services and 168 health care providers at 6 Wellbeing Centers in 4 districts in Bangladesh. Data collection involved both quantitative and qualitative methods. Implementation outcomes were measured following the World Health Organization's implementation research framework. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 questionnaires. Descriptive statistics and adjusted odds ratios (aORs) with 95% CIs were used to evaluate the implementation outcomes. Qualitative information was obtained through in-depth interviews and key-informant interviews. Almost all health care providers (165/168, 98.2%) reported that the Wellbeing Centers were feasible to implement in their health facilities; however, about half (84/168, 50%) felt that trained staff to operate them were insufficient. Almost all women agreed that the Wellbeing Centers were acceptable (906/911, 99.8%), useful (909/911, 99.8%), and enhanced access to mental health care (906/911, 99.5%). Patients visiting district-level hospitals had higher odds of access (aOR 1.5, 95% CI 1.1-2.0) to Wellbeing Centers. Moreover, 77.4% (705/911) of women experienced depression symptoms, and 76.7% (699/911) experienced anxiety symptoms. About 51.8% (472/911) experienced tiredness or lack of energy, 50.9% (464/911) felt nervous, anxious, or on edge, 57.2% (521/911) felt worried, and 3.8% (35/911) had suicidal ideation almost every day. Patients visiting district hospitals had higher odds (aOR 2.6, 95% CI 1.8-3.78) of depression and anxiety symptoms compared to the patients visiting subdistrict-level hospitals. Decreasing trends in Patient Health Questionnaire-9 scores (from mean 14.4, SD 0.47 to mean 12.9, SD 0.47) and Generalized Anxiety Disorder-7 scores (from mean 13.3, SD 0.49 to mean 12.5, SD 0.48) between 2 counseling sessions indicated improved mental health in the antepartum and postpartum women. The Wellbeing Centers' services were appreciated for their privacy and being free and accessible. However, stigma, postpartum illness, and long waiting times prevented some women from using these services. To our knowledge, this is the first implementation research assessing telemental health in public health facilities involving trained psychologists and psychiatrists. Our study highlighted the increased accessibility, feasibility, acceptability, and utility of Wellbeing Centers for antepartum and postpartum women in Bangladesh, supporting their scale-up in similar settings.

Perceived Telehealth Usability for Personalized Healthcare Among the Adult Population in Saudi Arabia: A Cross-Sectional Study in the Post-COVID-19 Era.

Background: Due to technological advancements, the demand for easily accessible and convenient healthcare services is rising globally. Thus, telehealth is gaining momentum that was previously unheard of. The Kingdom of Saudi Arabia (KSA) actively embraces digital innovation in the healthcare industry through its ambitious Vision 2030 initiative. This study aimed to assess the perceived usability of telehealth for personalized healthcare among the KSA adult population in the post-COVID-19 era. Methods: This cross-sectional study used a convenience sample of 975 adults from the general population in KSA. A digital survey was used for data collection through Survey Monkey software. It contained two sections: personal and health data and the Telehealth Usability Questionnaire (TUQ). The data was collected over three months (July-September 2024) and investigated using the multinomial logistic regression analysis. Results: This study showed that 59.8% of the participants have initiated telehealth service use before the COVID-19 pandemic, and the most frequently used services are the issuance of sick leave (30.6%), tele-prescription (29.0%), virtual consultation (20.0%), tele-mental health services (19.4%), telemonitoring (18.6), and tele-referral (18.2%). A high total telehealth usability score was observed among 60.4% of the participants: 72.7% perceive telehealth as highly useful, 76.4% perceive it as easy to use, 60.1% have high satisfaction and intention for future use, 57.4% perceive high interface quality, and 51.8% perceive a high interaction quality. Conversely, 45.8% perceive low reliability of the telehealth system. Multinomial logistic regression showed that low education (AOR = 2.04; 95% CI = 1.16-4.85) and using virtual consultation (AOR = 0.98; 95% CI = 0.38-0.99) were predictors of low telehealth usability. However, being female (AOR = 1.67; 95% CI = 1.27-2.55), being in higher education (AOR = 1.47; 95% CI = 1.02-2.34), and living in the central KSA region (AOR = 1.37; 95% CI = 1.10-2.23) were predictors of high telehealth usability. Working status, income, and presence of chronic disease were not statistically significant predictors. Conclusions: Telehealth services have been highly usable in KSA even before the COVID-19 pandemic, with commonly used asynchronous services. Many social, technological, and system-related factors could affect the user experience and system reliability. Hence, telehealth developments are recommended to overcome such barriers, with future initiatives focusing on the flexibility and convenience of telehealth systems.

Health Care Utilisation and Unmet Needs in Survivors ofHead and Neck Cancer in Regional Australia: A Cross-Sectional Survey.

The post-treatment survivorship period marks the transition away from acute care and poses distinct challenges for individuals with head and neck cancer (HNC). This can be especially challenging for people in regional areas who travel long distances to access care and experience unique challenges in accessing health services. To investigate unmet needs and healthcare utilisation of survivors of HNC in regional areas. Invitations were sent to 619 survivors of HNC living in rural New South Wales, Australia, who were 1-15years post-treatment. Participants self-reported unmet survivorship needs and the strength of these needs using the Cancer Survivors' Unmet Needs Measure. Health care utilisation over the preceding 12months was collected using an investigator-designed questionnaire. One hundred and seventeen responses were received (19% response rate). Participants were predominantly male (65%), had oropharynx cancer (52%), with mean age of 70.2years. Some 54% of participants reported at least one unmet need, and 40% rated these unmet needs as 'strong'. Top unmet needs included concern about recurrence (24%), access to local services (15%), and financial support (15%). 94% of participants reported seeing their GP, while 62% visited a dental clinic; only 10% sought professional psychosocial support despite prevalent unmet needs. Rural survivors of HNC in Australia have substantial unmet psychosocial needs yet demonstrate low utilisation of professional psychosocial support. This may reflect the limited availability or accessibility of services for this population, which could be addressed with shared models of care utilising both GP-led and telehealth services.

Disparities in telehealth utilization between US rural and urban areas during the COVID-19 pandemic.

During the COVID-19 pandemic, telehealth services were expanded across the United States to meet the increased demand and safety requirements of care. This observational study aims to understand rural-urban differences in telehealth utilization during the early part of the COVID-19 pandemic. Individual-level data from the National Health Interview Survey 2020-2021 (age ≥18) were analyzed for this study. The Propensity Score Matching method with multivariable Ordinary Least Square was used to analyze 2 outcome variables-(1) having a medical appointment by video or phone in the past 12 months and (2) having a virtual one for reasons related to the pandemic. Event study models were analyzed to understand the trend of telehealth utilization throughout 6 quarters of the pandemic. Subgroup analysis by health insurance, age, sex, race, citizenship, and disability status was performed to identify underlying disparities between rural and urban residents. Analysis reveals that rural respondents (N = 6,984) were 8.7 percentage points (P<.001) less likely than urban respondents (N = 40,207) to have a medical appointment by video or phone. Rural residents were 8.1 percentage points (P<.001) less likely to have had a virtual medical appointment because of reasons related to the COVID-19 pandemic than urban users. The event study showed that rural-urban telehealth utilization disparities persisted throughout the pandemic. Subgroup analysis revealed significant rural-urban disparities in telehealth utilization by demographic characteristics. Results demonstrate that rural residents were less likely than urban residents to utilize telehealth services during the COVID-19 pandemic, highlighting concerns about access to care for rural residents.

Occupational health professionals' and HR specialists' perceptions of telemental health services in occupational health care settings: A qualitative study.

The rise in mental health-related work disability pensions highlights the need for more research on how occupational health care (OHC) can support mental health, including the use of telehealth (TH) services in mental health care. The research, employing a descriptive qualitative approach through interviews (n = 42), focused on experiences of professionals from a private OHC service provider in Finland and human resource representatives (HRRs) of OHC client companies. Inductive content analysis was used to analyze the data. Our research suggests that TH services provided by OHC can enhance access to care and expedite the initiation of work ability support, particularly in mental health cases. However, potential challenges include a perceived sense of distance, superficiality in interactions, and difficulty in forming a comprehensive understanding due to few non-verbal cues. A combined approach of TH and face-to-face services is suggested to provide flexible, and individualized support. Further studies on remote low-threshold discussion mental health services and studies comparing TH and face-to-face services are advised.

Assessing the Efficacy of Telehealth Services in Rural Areas

Assessing the Efficacy of Telehealth Services in Rural Areas

Telehealth in Acute Care: Pay Parity and Patient Access

Problem definition: In response to the increased use of telehealth to replace traditional office visits with a physician, several U.S. states have recently adopted telehealth pay-parity policies. Such policies state that payers must reimburse healthcare providers for telehealth services at the same rate that would apply if those services had been provided in a traditional office setting. But health policy researchers have pointed out that telehealth may not be as effective as a traditional office visit for acute care. Specifically, telehealth is associated with increased probability of a subsequent office visit (a “duplicate visit”). We examine whether telehealth pay-parity policies are effective at improving access to acute care, and under what conditions. Methodology/results: We use a three-stage game-theoretic model to study the impact of telehealth pay parity. In the first stage, the payer sets a reimbursement policy for telehealth visits. In the second stage, a healthcare provider commits a portion of its capacity to telehealth, and in the third stage, patients arrive and choose between telehealth and office visits according to an equilibrium queueing network. We find structural results for the equilibria and characterize the equilibria in closed-form. When the chance of a duplicate visit is moderate (neither too high nor too low), pay parity leads providers to allocate too much capacity to telehealth, resulting in lower overall patient access than could be otherwise achieved. We characterize a reimbursement level that avoids this misalignment and maximizes patient access, which we show is less than parity. Managerial implications: The literature shows that patients receiving acute care via telehealth may be more likely to require a duplicate, in-person visit to resolve their health concern. In the fee-for-service environment that is common in the United States for acute care, duplicate visits resulting from telehealth lead to an incentive alignment problem because they generate extra work and provider revenue, without any corresponding increase in patient access. Legislating pay parity for telehealth can lead to providers committing more capacity to telehealth, which may not always be good. However, there is good news in that all parties (payers, providers, and patients) would be better off if duplicate visits could be decreased. Policy makers should understand these implications before enacting policies that affect reimbursements for telehealth. Funding: Support for this project was provided by a PSC-CUNY Award, jointly funded by The Professional Staff Congress and The City University of New York. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0345 .