Abstract
Background: As the largest payor of mental health services in the U.S., Medicaid is a responsive mechanism for the approximately 48% of people with mental illnesses (PMI) insured by this payor source (Adelmann, 2003). The 2010 expansion of Medicaid services in the U.S. improved coverage for specialized mental healthcare treatment (Blunt et al., 2020; Breslau et al., 2020), but several barriers persist in mental healthcare among Medicaid beneficiaries. Yet, telehealth services are crucial in responding to the access, adherence, and appointment keeping needs of Medicaid beneficiaries (Adepoju et al., 2022; Creedon et al., 2020; McBain et al., 2023).
Purpose: To assess the responsiveness of telehealth use on adherence and healthcare utilization among adult PMI.
Methods: A cross-sectional analysis of 2018 to 2022 Kentucky State Medicaid claims dataset of adult PMI. Demographic, psychiatric diagnosis, residence, payor type, medication adherence, healthcare visits and costs, and telehealth use codes were extracted. Linear or logistic regression analyses were used to examine the effect of telehealth use on adherence, visits, and costs.
Results: Participants were mostly female, White non-Hispanic, and urban residents. Only 0.5% of the beneficiaries had any telehealth visit codes. When controlling for other study variables, telehealth use was associated with greater medication adherence (OR=2.1, 95%CI=1.8-2.5), mean number of outpatient visits (β=2.0, t=16.4, p<.001), any outpatient visit (OR=6.1, 95%CI=4.9-7.7) and higher pharmacy costs (β=2.2, t=10.8, p<.001). Further, telehealth use was associated with lower mean number of emergency visits (β=-0.5, t=4.1, p<.001) any emergency visits (OR=0.9, 95%CI=0.8-0.9) and outpatient costs (β=-0.6, t=13.1, p<.001).
Discussion: Telehealth was underutilized among our sample of PMI. This underutilization presents an opportunity for nurses to advocate for policies to improve telehealth services access. Based on our findings of greater medication adherence and lower healthcare utilization (related to emergency visits and outpatient costs), nursing leaders may consider the financial benefits of adopting telehealth services into care delivery settings. Future studies may examine strategies to enhance telehealth adoption to improve treatment outcomes while balancing healthcare utilization. Such studies will be important to leverage the adoption of such novel technologies for PMI globally.
Notes
Reference list included in attached slide deck.
Sigma Membership
Delta Psi at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Cross-Sectional
Research Approach
Other
Keywords:
Health Equity, Social Determinants of Health, Sustainable Development Goals, Policy and Advocacy, Emerging Technologies, Telehealth, Healthcare Utilization and Adherence
Recommended Citation
Okoli, Chizimuzo T.C.; Wang, Tianyi; Seng, Sarret; Abufarsakh, Bassema; Almogheer, Zainab; Al-Kayed, Jarrah; Bhattarai, Pooja; Stith, Holly; and Makowski, Andrew, "A Reflection on the Use of Telehealth to Improve Treatment Adherence and Healthcare Utilization" (2025). Biennial Convention (CONV). 85.
https://www.sigmarepository.org/convention/2025/presentations_2025/85
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-11-26
Funder(s)
Cabinet for Health and Family Services, Kentucky, USA
A Reflection on the Use of Telehealth to Improve Treatment Adherence and Healthcare Utilization
Indianapolis, Indiana, USA
Background: As the largest payor of mental health services in the U.S., Medicaid is a responsive mechanism for the approximately 48% of people with mental illnesses (PMI) insured by this payor source (Adelmann, 2003). The 2010 expansion of Medicaid services in the U.S. improved coverage for specialized mental healthcare treatment (Blunt et al., 2020; Breslau et al., 2020), but several barriers persist in mental healthcare among Medicaid beneficiaries. Yet, telehealth services are crucial in responding to the access, adherence, and appointment keeping needs of Medicaid beneficiaries (Adepoju et al., 2022; Creedon et al., 2020; McBain et al., 2023).
Purpose: To assess the responsiveness of telehealth use on adherence and healthcare utilization among adult PMI.
Methods: A cross-sectional analysis of 2018 to 2022 Kentucky State Medicaid claims dataset of adult PMI. Demographic, psychiatric diagnosis, residence, payor type, medication adherence, healthcare visits and costs, and telehealth use codes were extracted. Linear or logistic regression analyses were used to examine the effect of telehealth use on adherence, visits, and costs.
Results: Participants were mostly female, White non-Hispanic, and urban residents. Only 0.5% of the beneficiaries had any telehealth visit codes. When controlling for other study variables, telehealth use was associated with greater medication adherence (OR=2.1, 95%CI=1.8-2.5), mean number of outpatient visits (β=2.0, t=16.4, p<.001), any outpatient visit (OR=6.1, 95%CI=4.9-7.7) and higher pharmacy costs (β=2.2, t=10.8, p<.001). Further, telehealth use was associated with lower mean number of emergency visits (β=-0.5, t=4.1, p<.001) any emergency visits (OR=0.9, 95%CI=0.8-0.9) and outpatient costs (β=-0.6, t=13.1, p<.001).
Discussion: Telehealth was underutilized among our sample of PMI. This underutilization presents an opportunity for nurses to advocate for policies to improve telehealth services access. Based on our findings of greater medication adherence and lower healthcare utilization (related to emergency visits and outpatient costs), nursing leaders may consider the financial benefits of adopting telehealth services into care delivery settings. Future studies may examine strategies to enhance telehealth adoption to improve treatment outcomes while balancing healthcare utilization. Such studies will be important to leverage the adoption of such novel technologies for PMI globally.
Description
Few studies have addressed treatment adherence and healthcare utilization outcomes of telehealth among Medicaid beneficiaries who are people with mental illness (PMI). Our study demonstrated that compared to those who do not use telehealth services, PMI who use telehealth services can have better medication adherence and lower healthcare utilization costs. Nurse leaders may reflect on the benefits of adopting telehealth in care delivery settings for PMI in a global context.