Literature Collection

Background: The Veterans Health Administration (VHA) piloted an innovative video telehealth program called Virtual Integrated Multisite Patient Aligned Care Teams (V-IMPACT) in fiscal year (FY) 2014. V-IMPACT set up one regional "hub" site where primary care (PC) teams provided regular PC through telehealth services to patients in outlying "spoke" sites that experienced gaps in provider coverage. We evaluated associations between clinic-level adoption of V-IMPACT and patients' utilization and VHA's costs for primary, emergency, and inpatient care. Materials and Methods: This observational study used repeated cross-sections of 208,612 unique veteran patients assigned to a PC team in 22 V-IMPACT spoke sites from FY2013 to FY2018. V-IMPACT adoption in a spoke site was indicated if more than 1% of patients assigned to PC in a site used V-IMPACT services during the year. Association between V-IMPACT adoption and outcomes were assessed using mixed-effects models. Results: V-IMPACT adoption was associated with increased telehealth visits for PC (incidence rate ratio [IRR] = 2.42 [1.29 to 4.55]) and for primary care mental health integration (IRR = 7.25 [2.69 to 19.54]). V-IMPACT adoption was not associated with in-person visits, or with total visits (in-person plus video telehealth). V-IMPACT adoption was also not associated with acute hospital stays, emergency department visits, or VHA costs. Conclusions: Programs such as VHA's V-IMPACT can increase telehealth visits for PC, allowing successful transition across modalities and facilitating continuity of care without impacting total care. Programs should track substitution of in-person visits with telehealth visits and examine its effects on patients' health outcomes, satisfaction, and travel costs.

OBJECTIVE: To examine how clinical care navigation-assistance in accessing healthcare and social services-relates to mental healthcare utilization and clinical outcomes, and whether effects are consistent for people of color. METHODS: This retrospective cohort study included participants using a digital mental health benefit (Spring Health), sponsored by 2,045 US employers from 2018-2023. Participants had access to therapists and Care Navigators, clinicians who help select treatment options and schedule appointments. Primary measures were care utilization (conversion to care, multiple-session attendance) and clinical effectiveness (treatment duration, PHQ-9 depression scale, GAD-7 anxiety scale). RESULTS: 36,964 participants had at least 1 mental health assessment and complete demographic information. 13,122 participants who used care navigation were matched to 23,842 participants who did not with 1:2 propensity score matching using demographic and clinical characteristics. Care navigation was associated with increased therapy utilization (OR, 7.10; 95% CI, 3.36-15.00, P < 0.001), multiple-session attendance (OR, 1.57; 95% CI, 1.46-1.69, P < 0.001), number of treatment sessions (IRR, 1.36; 95% CI, 1.33-1.39, P < 0.001), additional clinical improvement (depression: 0.93 points, 95% CI, 0.11-1.75; anxiety: 0.87 points, 95% CI, 0.12-1.62) compared to therapy alone for participants with severe baseline symptoms. White participants and participants of color had similar outcomes. CONCLUSIONS: Participants using care navigation had improved mental healthcare utilization, retention, and reduced depression and anxiety, which was consistent for people of color. Clinical implementation of care navigation may be associated with greater engagement in care, a key requisite for improving treatment outcomes.

BACKGROUND: Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) co-occur frequently and have deleterious impact. Seeking Safety (SS) - an evidence-based, present-focused, coping skills model - lends itself to mobile app delivery. OBJECTIVES: A novel SS mobile app is compared to a control app that lacks the interactivity, social engagement, and feature-richness of the SS app. We hypothesized that the SS app would outperform the control on primary outcome variables (substance use, trauma symptoms) and at least two secondary variables. METHODS: Outpatients with current PTSD and SUD (n = 116) were randomized to the apps; assessed were pre, post (12 weeks), and 3-month follow-up in this online study. RESULTS: The SS app outperformed the control on the primary outcomes, but not on secondary outcomes. Also both conditions evidenced significant change over time from pre to post, with gains sustained at follow-up. External medication and supports during the trial did not differ by condition. CONCLUSION: This first RCT on a SS mobile app had positive results for reduction in substance use and trauma symptoms compared to a control app. This is noteworthy as mental health mobile apps, in general, evidence few positive outcomes. Our substance use finding is also notable as psychosocial interventions in PTSD/SUD populations find it harder to achieve reduction in SUD than trauma symptoms. Our control app may have represented too strong a comparison and weakened our ability to find results on secondary outcomes by condition.