Disparities in Telehealth Access Undermine Adoption Among Patients With Schizophrenia

Findings showed racial and ethnic disparities, as minority groups faced slower access to their first telemental health care visit.

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The COVID-19 pandemic accelerated the widespread adoption of telemental health care. However, research published today in JAMA Network Open indicates significant racial and ethnic disparities in access to this technology among Medicaid beneficiaries with schizophrenia.¹ A retrospective cohort study utilizing data from New York State Medicaid highlights the rapid acceptance of telemental health care while also revealing inequities affecting racial and ethnic minority groups.

The analysis, including 261 mental health agencies, revealed significant findings regarding the rapid diffusion of telemental health care during the pandemic. Remarkably, 95% of these agencies achieved at least 10% cumulative use of telemental health services, typically within an average of 18 days following the pandemic's onset. State-operated agencies exhibited a quicker adoption of this innovation compared with free-standing agencies, with a hazard ratio (HR) of 2.44 (95% CI, 1.21-4.95).

However, the study also highlighted racial and ethnic disparities, as minority groups faced slower access to their first telemental health care visit. When compared with White beneficiaries, Asian individuals and those of other racial/ethnic backgrounds (HR, 0.93; 95% CI, 0.88-0.98), Black individuals (HR, 0.90; 95% CI, 0.87-0.93), and Latinx individuals (HR 0.95 (95% CI, 0.91-0.99) experienced delayed access.

During periods of heightened pandemic severity, the researchers observed that these racial disparities in access began to narrow. In New York City, Black beneficiaries were 30% less likely than their White counterparts to utilize telemental health care during high-severity periods (OR, 0.70; 95% CI, 0.63-0.79), but this disparity increased to 41% during low-severity periods (OR, 0.59, 95% CI, 0.53-0.67).

The study poses these findings within broader patterns of inequities, such as slower diffusion of novel antipsychotics and disparities in access to enabling technology. Geographically, racial and ethnic differences in access persisted but were less pronounced when the health care system was under greater stress, suggesting that vulnerable groups were prioritized during critical periods.

State-operated agencies led in adopting telemental health care, likely due to their familiarity with state procedures and access to resources, the authors noted. Hospital-affiliated agencies lagged, potentially due to their less flexible structures compared with smaller, more integrated, free-standing agencies.

Megan Ehret, PharmD, MS, BCPP, professor and codirector of the Mental Health Program, University of Maryland, School of Pharmacy, explained to The American Journal of Managed Care^® that while there was an increase in patients using telehealth treatment for schizophrenia following the pandemic, it’s not necessarily the best method of care for everyone due to technology and housing barriers.²

“When our patients are homeless or if they're in and out of different locations and living in transitions of care, it can be very hard to track down patients,” she stated in the interview. “This makes it more challenging, and when treatment adherence is so important, that engagement with the provider can be ideal.”

Despite its strengths, the current study acknowledged its limitations, including partial adjustments for severity indicators, a focus on New York Medicaid data that limits generalizability, and a lack of differentiation between audio-only and audiovisual telehealth services.¹

“More research is needed to confirm and expand our novel diffusion findings, but some steps may be taken immediately,” the authors wrote. “States should monitor the diffusion of innovations among vulnerable populations, investigating whether adoption speed varies by race and ethnicity. States should also examine factors associated with access to the innovation, paying particular attention to the role of agencies, and implement corrective strategies, such as financial incentives targeted to underperforming agencies if evidence of inequities is found.”

References

1. Normand SL, Leckman-Westin E, Finnerty M, et al. Race and ethnicity and diffusion of telemedicine in Medicaid for schizophrenia care after onset of the COVID-19 pandemic. JAMA Network Open. 2025;8(1):e2454776. doi:10.1001/jamanetworkopen.2024.54776

2. Joszt L. Unmet needs and the importance of social support in schizophrenia. AJMC. October 27, 2024. Accessed January 15, 2025. https://www.ajmc.com/view/unmet-needs-and-the-importance-of-social-support-in-schizophrenia