Ryoichi Nakajima, Hiroshi Kamada, Taishu Kasai, Yohei Tomaru, Miki Waku, Ayano Yamaki, Atsuhiko Ban, Shumpei Miyakawa, Masashi Yamazaki, Hitoshi Shiraki
Effect of temporary school closure due to COVID-19 on musculoskeletal function in elementary school children
Journal of rural medicine : JRM
united states veterans health administration leader use telemental health tmh enhance access mental healthcare amidst nationwide shortage mental health professionals tennessee valley veterans affairs va health system piloted tmh emergency department ed urgent care clinic ucc 2019 full 247 availability beginning march 1 2020 following implementation preliminary data demonstrated veterans 65 years old less likely receive tmh younger patients sought examine factors associated older veterans receiving tmh consultations acute unscheduled outpatient settings identify limitations current process retrospective cohort study conducted within tennessee valley va health system included veterans 55 years received mental health consultation ed ucc april 1 2020september 30 2022 telemental health administered mental health clinician attending physician resident physician nurse practitioner physician assistant via ipad whereas inperson evaluations performed ed examined influence patient demographics visit timing chief complaint psychiatric history tmh using multivariable logistic regression 254 patients included analysis 177 697 received tmh veterans highrisk chief complaints suicidal ideation homicidal ideation agitation less likely receive tmh consultation adjusted odds ratio aor 047 95 confidence interval ci 024095 compared attending physicians nurse practitioners physician assistants associated increased tmh use aor 481 95 ci 2041136 whereas consultation resident physicians associated decreased tmh use aor 004 95 ci 000059 ucc used tmh one encounter patient characteristics including visit timing gender additional medical complaints comorbidity burden number psychoactive medications influence use tmh highrisk chief complaints location type mental health clinician may key determinants telemental health use older adults may help expand mental healthcare access areas shortage mental health professionals prevent potentially avoidable transfers lowacuity situations studies interventions may optimize tmh older patients ensure safe equitable mental health care