Racial/Ethnic and Language Disparities in Telepsychiatry during the COVID‐19 Pandemic: Results from an Urban Safety‐Net Hospital System

Research Objective To estimate racial/ethnic and linguistic disparities in access to and utilization of outpatient mental health care before and after the rapid implementation of telepsychiatry during the COVID-19 pandemic. Study Design We used electronic health record data from an urban safety-net healthcare system on appointments, patient's diagnoses, demographics, location of care, and provider type. Data included outpatient mental health service use for the periods before (pre-period = March?June 2019) and after (post-period = March?June 2020) the introduction of telepsychiatry. Outcomes consisted of outpatient mental health service use and no-show visits, which were operationalized as both dichotomous and count variables. We estimated multivariable linear probability regression models (dichotomous outcome) and negative binomial regression models (count outcome). The primary term of interest was an interaction between race/ethnicity (White [referent], Black, Latino, and Asian) and time indicator (1 = post-period, March?June 2019;and 0 = pre-period, March?June 2020) that yielded the difference in service use between White patients and racial/ethnic minority patients. In secondary analysis, the term of interest was an interaction between language of service preference (English [referent], Spanish, Portuguese, and Haitian Creole) and time indicator. We used predictive margins methods to estimate predicted probabilities, predicted means, interpret interactions in nonlinear models, and estimate within group differences. All regression models adjusted for a rich set of covariates. Population Studied Analytic sample consisted of adults between the ages of 18?64 that received mental health services from the safety-net healthcare system under study between March 2019 and June 2020 (n = 254,995). We further classified our population by race/ethnicity (White, Black, Latino, and Asian) and language of service preference (English, Spanish, Portuguese, and Haitian Creole). Principal Findings In adjusted results, between pre- and post-periods, all racial/ethnic and linguistic groups had significant within-group increases in access to and use of outpatient mental health care (all p?