Dual Use of a Patient Portal and Clinical Video Telehealth by Veterans with Mental Health Diagnoses: Retrospective, Cross-Sectional Analysis (Preprint)

Abstract

Background: Access to mental health care is challenging. The Veterans Health Administration (VHA) has been addressing these challenges through technological innovations including the implementation of clinical video teleconferencing (CVT), two-way interactive, synchronous videoconferencing between a provider and a patient, and an electronic personal health record, My HealtheVet (MHV).Objectives: The goal of this study was to describe early adoption and use of MHV and CVT among VHA users with mental health diagnoses. Methods:We conducted a retrospective, cross-sectional analysis of early MHV adoption and CVT engagement among Veterans with one or more mental health diagnoses who were VHA users from 2007-2012. We categorized Veterans into four eHealth technology use groups: MHV only, CVT only, complementary users who used both, and non-users of either. We examined demographic characteristics and mental health diagnoses by group. We explored MHV feature use among MHV adopters. We then explored predictors of MHV adoption, CVT engagement, and complementary use using multivariate logistic regression.Results: Among 2.17 million Veterans with one or more mental health diagnoses, only 32,723(1.5%) were complementary users, with most (71.7%) being non-users of both MHV and CVT.African-American and Latino patients were significantly less likely to engage in CVT or use MHV, compared to White patients. Low-income patients who met the criteria for free care were significantly less likely to be MHV or complementary users than those who did not. The odds of CVT engagement and complementary use decreased with increasing age. Women were more likely than men to be MHV or complementary users, but less likely than men to be CVT users. Conclusions: Use of these technologies was still relatively low, leaving much potential for growth. There were regional and socio-demographic disparities in access to MHV and CVT, and in complementary use of these technologies. There was also variation based on types of mental health diagnosis. More research is needed to ensure that these and other patient-facing eHealth technologies are accessible and effectively used by all vulnerable patients.