Tablets and telehealth: expanding care reach by closing the digital divide.

INTRODUCTION: Some health conditions and life experiences can create disclosure costs (ie, anticipated social costs of care-seeking), suppressing care-seeking in ways that logistical access alone cannot resolve. Digital infrastructure enabling telehealth access holds promise for reaching these populations because remote access reduces the visibility of care-seeking. Yet, device access remains a barrier, with little evidence on whether internet-enabled device distribution programs can expand care for high-disclosure-cost populations.

METHODS: Using an event study and difference-in-differences framework, this study exploits the Department of Veterans Affairs' (VA's) escalated distribution of video-enabled tablets during the COVID-19 pandemic to identify the impact of closing the digital divide on continuity of virtual mental health care among female veterans with a history of military sexual trauma and examines variation in impact by clinician characteristics.

RESULTS: Tablet recipients experienced a 27% increase in continuity of care and attended 2.5 more psychotherapy visits per year for both general mental health and trauma-related concerns. Effects were larger among patients matched with female or female-serving clinicians, suggesting that device access and clinician characteristics may work together to facilitate care for trauma survivors.

CONCLUSION: These findings suggest that public investment in digital infrastructure paired with intentional, preference-honoring patient-provider matching may expand mental health care access for patients whose barriers extend beyond logistics to the visibility of care-seeking.