Pain psychology service utilization and socioeconomic disparities following telehealth implementation

This natural experiment study examined associations between system-wide telehealth implementation and pain psychology service utilization and socioeconomic disparities among patients with chronic pain. Electronic health record data from 2776 adults referred to a pain psychology clinic were analyzed across two 36-month periods: pre-telehealth (March 2017-February 2020, in-person care) and post-telehealth (April 2020-March 2023, video-based care). Outcomes included evaluation scheduling rates, attendance rates, treatment adherence ratios, and wait times. Socioeconomic indicators were insurance type (Medicaid, Medicare, Commercial, Other) and neighborhood disadvantage (Area Deprivation Index). Multivariable regression models examined period effects and socioeconomic disparities, with interaction analyses testing whether telehealth moderated disparities. Post-telehealth, evaluation scheduling rates decreased (OR=0.82, 95% CI: 0.70-0.97), but treatment attendance ratios significantly improved (median 87.5% vs 72.1% pre-telehealth; β=0.054, 95% CI: 0.014-0.095). Referral-to-evaluation wait times increased overall (β=11.6 days, 95% CI: 4.5-18.8) but decreased specifically for Medicaid patients relative to commercially insured patients (interaction β= -31.2 days (95% CI: -56.5, -5.9); p=0.016). Significant socioeconomic disparities persisted: Medicaid patients had lower evaluation attendance (OR=0.47, 95% CI: 0.32-0.70) and treatment ratios (β=-0.085, 95% CI: -0.156 to -0.014); higher neighborhood disadvantage predicted lower attendance (OR=0.90 per 10-point increase, 95% CI: 0.84-0.95). Telehealth implementation did not moderate most disparities. While the post-telehealth period was associated with improved treatment adherence and reduced specific wait time disparities, fundamental socioeconomic barriers to accessing pain psychology services persisted. PERSPECTIVE: Treatment adherence for pain psychology substantially improved during the post-telehealth period but socioeconomic disparities in access persisted. Findings suggest policies supporting telehealth reimbursement may benefit from being coupled with targeted strategies addressing technology access and systemic barriers for vulnerable populations.