The Impact of Co-occurring Anxiety and Alcohol Use Disorders on Video Telehealth Utilization Among Rural Veterans

Abstract

Co-occurring anxiety and alcohol use disorders lead to poorer treatment outcomes for both disorders. Compounding risk for poor outcomes related to these disorders, individuals living in rural areas face barriers receiving evidence-based mental health treatment. Video to home telehealth (VTH) has been implemented broadly within the Veterans Health Administration to improve access to care for rural veterans. However, VTH may not be utilized equally across disorders and comorbidities, including cooccurring anxiety and alcohol use disorders, potentially contributing to gaps in care that are not available in person. A cohort of veterans who received at least one VTH mental health visit between fiscal years 2016-2019 was compiled from VA administrative data. Multilevel linear growth curve models were used to examine growth in VTH use over time among veterans with anxiety only, alcohol use disorder only, and co-occurring disorders. Fixed effects were significant for both time and diagnosis group and a significant interaction between time and group. For each subsequent fiscal year, the percentage of total MH visits that were VTH increased for all groups but less so for those with co-occurring anxiety and alcohol use diagnoses. Despite VTH being an important tool to reach underserved rural veterans, rural veterans with AUD and co-occurring anxiety and AUD are at risk for not receiving care using this modality. Findings suggest that veterans with co-occurring anxiety and AUD are especially at risk for being underserved, given that a major goal of VTH is to increase access to mental health services. Keywords Anxiety disorders. Alcohol use disorder. Veterans. Telemedicine Anxiety disorders are among the most common psychiatric disorders, with a prevalence rate of 18% (Kessler et al. 2005). In a

The Good, The Bad, The Uncertain: Diverse Provider Experiences with Telemental Health During COVID-19

“…Findings suggest overall positive experiences, with cited benefits for the patients and health care systems, and satisfaction with maintaining continuity of care and increased scheduling flexibility [17]. However, challenges and barriers persist regarding technology problems and outcome monitoring, lack of TMH trainings, and concerns around using TMH for new visits and for populations for which current practice of TMH may be ill-suited or building therapeutic alliance would be more challenging, including children [18], vulnerable groups such as refugees [19] and rural or homeless populations [5,20,21].…”

Use of Video Telehealth Tablets to Increase Access for Veterans Experiencing Homelessness

“…8 -10 Patient populations who face sociodemographic and clinical challenges (e.g., travel distance to care for rural patients) can benefit from video telehealth. [11][12][13][14][15][16] Other vulnerable populations that have been shown to benefit from video telehealth include older adults, [17][18][19][20][21] African American and Hispanic adults, [22][23][24][25] and Native and Alaskan American adults; 26,27 and patients with mental health conditions such as anxiety and depression 28 or anxiety and alcohol use disorder, 29,30 post-traumatic stress disorder (PTSD), 31,32 substance use disorder (SUD); [33][34][35] or challenges with medication adherence. 36 One VA patient population that could potentially benefit from virtual care is Veterans experiencing homelessness, representing 8% (n=37,085) of all US homeless adults.…”

“…For housed Veterans and Veterans experiencing homelessness: missing values exist in marital status (223), race/ethnicity (435), enrollment priority group (118), geographic location (156). For urban and rural homeless tablet recipients: missing values exist in marital status(29), race/ethnicity (44), enrollment priority group(6). *All P-values for continuous variables derive from t-tests and P-values for categorical variables derive from chi-square tests.…”