Health Services/Policy
Who Uses Telehealth, Where, and When? Exploring Use of Psychiatric and Primary Care in Electronic Health Records of Patients with Depression Catherine Ettman* Catherine Ettman Jason Straub Grace Ringlein Carly Lupton Brantner Elizabeth Chin Elena Badillo Goicoechea Priya Dohlman Fernando S. Goes Elizabeth A. Stuart Peter P Zandi
While telehealth has the possibility to improve access to healthcare for some, it may create disparities for others who may not have access to it. We sought to understand: 1) are there differences in who uses telehealth; 2) do telehealth usage patterns differ across primary versus psychiatric care? Using electronic health record data for two cohorts of patients with depression in a large U.S. academic medical system, we assessed telehealth use for primary care and psychiatric care from July 1, 2020, through December 31, 2023. Our sample includes patients ages >10 years in the Johns Hopkins Medicine System with a depression diagnosis with appointments in the Department of Psychiatry (n=15,218) or Johns Hopkins Community Physicians (n=44,243). We estimated the odds ratio of an appointment happening over telehealth versus in-person using multivariable logistic regression with random effects at the patient level (to account for repeated visits) for each patient characteristic: sex, age, race and ethnicity, employment, area deprivation index (ADI), insurance, and psychiatric co-morbidities (i.e., history of substance use disorder (SUD), anxiety disorder, and suicidal ideation or attempt). First, the following characteristics were associated with greater use of telehealth in both psychiatric and primary care from July 1, 2020, through October 21, 2023: female sex, White race, full-time employment, private health insurance, lower ADI, ages 18-64, and co-morbid anxiety. Second, we found that the following patient groups were more likely to use telehealth when controlling for all other patient characteristics and appointment characteristics (time of day, day of week, month, lead time) across both psychiatric and primary care: age (18-64 years), employment, lower ADI, and anxiety. In fully adjusted models, age, employment, and living in higher socio-economic areas were associated with lower odds of using telehealth, suggesting that access to resources may be a central driver of differences in telehealth use. Telehealth use may be concentrated among patients with higher socioeconomic status. Efforts to improve access to telehealth can help to reduce inequities in access to mental health treatment between patients with more and fewer economic resources.