Telebehavioral Health, In-Person, and Hybrid Modalities of Treatment Delivery Among US Service Members: Longitudinal Observational Study.

Background: The availability of telebehavioral health care dramatically increased in response to the COVID-19 pandemic among both civilian and military populations. After the restrictions were lifted, telebehavioral health use decreased but remained elevated compared to before the pandemic. Examining the use of treatment modalities and how they relate to care metrics can inform the future delivery of behavioral health care. Objective: This study aimed to explore behavioral health use patterns by treatment modality (telehealth, in-person, and hybrid care) among active duty service members with at least 1 of 12 behavioral health conditions. Treatment modality groups were also compared on the number of visits and between-visit intervals to determine the association with care metrics. Methods: The study included 588,928 active duty service members who completed at least 6 months of continuous service during the study period (October 1, 2015, to September 30, 2021) and received care for at least 1 behavioral health condition of interest. Personnel and demographic data were matched with medical reimbursement records. Diagnostic and treatment procedure codes were extracted for each health care visit. For each service member in the study population, the total number of behavioral health visits, modality of each visit, and average duration of time between visits were calculated. Results: Overall, 59.57% (350,843/588,928) of service members received only in-person care during the 6-year study period, 4.12% (24,245/588,928) received only telehealth, and 36.31% (213,840/588,928) received hybrid care. For 8 (66.7%) of the 12 behavioral health conditions (eg, alcohol use disorder, attention-deficit/hyperactivity disorder, generalized anxiety disorder, major depressive disorder, panic disorder, posttraumatic stress disorder, substance use disorder, and suicidal behavior), service members were more likely to receive hybrid care, whereas the other 4 (41.7%) conditions (eg, acute stress disorder, adjustment disorder, insomnia, and suicidal ideation) were more likely to be associated with in-person care. Service members who received hybrid care averaged 8 times more visits than those using only telehealth and 3 times more visits than those receiving only in-person care. For most conditions, service members who received in-person care only averaged the longest intervals between visits, whereas those who used telehealth care only averaged the shortest intervals. Among specific behavioral health conditions, average intervals were longest among those with attention-deficit/hyperactivity disorder, acute stress disorder, and insomnia (79-89 d) and shortest among those with suicidal behavior, substance use disorder, and alcohol use disorder (25-38 d). Conclusions: Telebehavioral health care was commonly used in combination with in-person care and associated with more health care visits and the least amount of time between visits, revealing advantages of offering telehealth within the Military Health System. Findings support a flexible care delivery approach that includes various modalities, such as telehealth, in-person, and hybrid options to address the behavioral health needs of service members.