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.