Quantifying the Digital Divide : Associations of Broadband Internet with Tele-mental Health Access Before and During the COVID-19 Pandemic
© 2023. The author(s)..
BACKGROUND: During the COVID-19 pandemic, telemedicine quickly expanded. Broadband speeds may impact equitable access to video-based mental health (MH) services.
OBJECTIVE: To identify access disparities in Veterans Health Administration (VHA) MH services based on broadband speed availability.
DESIGN: Instrumental variable difference-in-differences study using administrative data to identify MH visits prior to (October 1, 2015-February 28, 2020) and after COVID-19 pandemic onset (March 1, 2020-December 31, 2021) among 1176 VHA MH clinics. The exposure is broadband download and upload speeds categorized as inadequate (download ≤25 Megabits per second - Mbps; upload ≤3 Mbps), adequate (download ≥25 Mbps and <100 Mbps; upload ≥5 Mbps and <100 Mbps), or optimal (download and upload ≥100/100 Mbps) based on data reported to the Federal Communications Commission at the census block and spatially merged to each veteran's residential address.
PARTICIPANTS: All veterans receiving VHA MH services during study period.
MAIN MEASURES: MH visits were categorized as in-person or virtual (i.e., telephone or video). By patient, MH visits were counted quarterly by broadband category. Poisson models with Huber-White robust errors clustered at the census block estimated the association between a patient's broadband speed category and quarterly MH visit count by visit type, adjusted for patient demographics, residential rurality, and area deprivation index.
KEY RESULTS: Over the 6-year study period, 3,659,699 unique veterans were seen. Adjusted regression analyses estimated the change after pandemic onset versus pre-pandemic in patients' quarterly MH visit count; patients living in census blocks with optimal versus inadequate broadband increased video visit use (incidence rate ratio (IRR) = 1.52, 95% CI = 1.45-1.59; P < 0.001) and decreased in-person visits (IRR = 0.92, 95% CI = 0.90-0.94; P < 0.001).
CONCLUSIONS: This study found patients with optimal versus inadequate broadband availability had more video-based and fewer in-person MH visits after pandemic onset, suggesting broadband availability is an important determinant of access-to-care during public health emergencies requiring remote care.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:38 |
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| Enthalten in: |
Journal of general internal medicine - 38(2023), Suppl 3 vom: 20. Juli, Seite 832-840 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
O'Shea, Amy M J [VerfasserIn] |
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| Links: |
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| Themen: |
COVID-19 |
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| Anmerkungen: |
Date Completed 21.07.2023 Date Revised 22.07.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s11606-023-08120-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a O'Shea, Amy M J |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Quantifying the Digital Divide |b Associations of Broadband Internet with Tele-mental Health Access Before and During the COVID-19 Pandemic |
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| 500 | |a Date Completed 21.07.2023 | ||
| 500 | |a Date Revised 22.07.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. The author(s). | ||
| 520 | |a BACKGROUND: During the COVID-19 pandemic, telemedicine quickly expanded. Broadband speeds may impact equitable access to video-based mental health (MH) services | ||
| 520 | |a OBJECTIVE: To identify access disparities in Veterans Health Administration (VHA) MH services based on broadband speed availability | ||
| 520 | |a DESIGN: Instrumental variable difference-in-differences study using administrative data to identify MH visits prior to (October 1, 2015-February 28, 2020) and after COVID-19 pandemic onset (March 1, 2020-December 31, 2021) among 1176 VHA MH clinics. The exposure is broadband download and upload speeds categorized as inadequate (download ≤25 Megabits per second - Mbps; upload ≤3 Mbps), adequate (download ≥25 Mbps and <100 Mbps; upload ≥5 Mbps and <100 Mbps), or optimal (download and upload ≥100/100 Mbps) based on data reported to the Federal Communications Commission at the census block and spatially merged to each veteran's residential address | ||
| 520 | |a PARTICIPANTS: All veterans receiving VHA MH services during study period | ||
| 520 | |a MAIN MEASURES: MH visits were categorized as in-person or virtual (i.e., telephone or video). By patient, MH visits were counted quarterly by broadband category. Poisson models with Huber-White robust errors clustered at the census block estimated the association between a patient's broadband speed category and quarterly MH visit count by visit type, adjusted for patient demographics, residential rurality, and area deprivation index | ||
| 520 | |a KEY RESULTS: Over the 6-year study period, 3,659,699 unique veterans were seen. Adjusted regression analyses estimated the change after pandemic onset versus pre-pandemic in patients' quarterly MH visit count; patients living in census blocks with optimal versus inadequate broadband increased video visit use (incidence rate ratio (IRR) = 1.52, 95% CI = 1.45-1.59; P < 0.001) and decreased in-person visits (IRR = 0.92, 95% CI = 0.90-0.94; P < 0.001) | ||
| 520 | |a CONCLUSIONS: This study found patients with optimal versus inadequate broadband availability had more video-based and fewer in-person MH visits after pandemic onset, suggesting broadband availability is an important determinant of access-to-care during public health emergencies requiring remote care | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, U.S. Gov't, Non-P.H.S. | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a internet access | |
| 650 | 4 | |a mental health | |
| 650 | 4 | |a telemedicine | |
| 650 | 4 | |a veterans | |
| 700 | 1 | |a Howren, M Bryant |e verfasserin |4 aut | |
| 700 | 1 | |a Mulligan, Kailey |e verfasserin |4 aut | |
| 700 | 1 | |a Haraldsson, Bjarni |e verfasserin |4 aut | |
| 700 | 1 | |a Shahnazi, Ariana |e verfasserin |4 aut | |
| 700 | 1 | |a Kaboli, Peter J |e verfasserin |4 aut | |
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