ArticleJournal of general internal medicine2023
Quantifying the Digital Divide: Associations of Broadband Internet with Tele-mental Health Access Before and During the COVID-19 Pandemic.
Article in Journal of general internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed.
- The telehealth engagement measure: a proportions-based measure of care delivered via video and phone for research, clinical, and policy assessments.JAMIA open · 2026Article
- Telehealth and the work behavior of mental health clinicians.Health affairs scholar · 2026Article
- Association Between Telehealth Delivery and Same-day Access to Integrated Mental Health in a National VA Sample.Journal of general internal medicine · 2026Article
- Telehealth Use and Modality Choice Among US Adults: Shorrocks-Shapley Decomposition of a 2022 Cross-Sectional National Survey.Journal of medical Internet research · 2026Article
- Mental Health Specialist Telemedicine Uptake and Patient Location.JAMA network open · 2026Article
- The second digital divide mediates the association between parental rearing style and depression, anxiety and their comorbidity among college students: a latent profile and mediation analysis.Frontiers in psychiatry · 2026Article
- Health care access from the rural perspective: A narrative review.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Review
- Site-Level Differences in the Provision of Telemental Health Care Within the Department of Veterans Affairs.Health services research · 2025Observational
- Satisfaction With Internet Access, Cancer Information-Seeking, and Digital Health Technology: Cross-Sectional Survey Assessment.Journal of medical Internet research · 2025Article
- Phone-only mental health care within the Department of Veterans Affairs: Associations with rurality, age, sex, and clinical severity.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- Telehealth Visits in Health Centers Serving Low-Income Patients in California: Final Results from the Connected Care Accelerator Initiative (2022-2024).Rand health quarterly · 2025Article
- Trends in mental health care and telehealth use across area deprivation: An analysis of electronic health records from 2016 to 2024.PNAS nexus · 2025Article
- Impact of a Remote Primary Care Telehealth Staffing Model on Primary Care Access in the Veterans Health Administration.Journal of general internal medicine · 2024Observational
- Evaluation of the Veterans Health Administration's Digital Divide Consult for Tablet Distribution and Telehealth Adoption: Cohort Study.Journal of medical Internet research · 2024Article
- The Association of Broadband Internet Use With Drug Overdose Mortality Rates in the United States: Cross-Sectional Analysis.Online journal of public health informatics · 2024Article
- Rural Veterans with HIV and Alcohol Use Disorder receive less video telehealth than urban Veterans.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2024Article
- More than One Divide: A Multilevel View of the Digital Determinants of Health.The Journal of pediatrics · 2024Article
- A Longitudinal Evaluation of a Novel Short-Term Staffing and Telehealth Program: A Retrospective Observational Study.Journal of primary care & community healthObservational
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDuring the COVID-19 pandemic, telemedicine quickly expanded. Broadband speeds may impact equitable access to video-based mental health (MH) services.
objectiveTo identify access disparities in Veterans Health Administration (VHA) MH services based on broadband speed availability.
designInstrumental 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.
participantsAll 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
resultsOver 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).
conclusionsThis 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.
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