Changes in the Use of Telehealth and Face-To-Face Chiropractic Care in the Department of Veterans Affairs Before and After the COVID-19 Pandemic

Roytman, Gregory; Coleman, Brian; Corcoran, Kelsey; Goertz, Christine; Long, Cynthia R.; Lisi, Anthony J.

doi:10.1016/j.jmpt.2021.12.002

Cited by 11 publications

(7 citation statements)

References 38 publications

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“…37,38 Telehealth alternatives have been found to be generally effective, however there are signs of declining use and a return to inoffice delivery of non-pharmaceutical services. [39][40][41][42][43][44] The aim of this study was to explore how the COVID pandemic impacted care-seeking for, and the management of, LBP in commercially insured (CI) and Medicare Advantage (MA) cohorts.…”

Section: (Which Was Not Certified By Peer Review)mentioning

confidence: 99%

Impact of the COVID-19 pandemic on low back pain management in commercially insured and Medicare Advantage cohorts. A retrospective cohort study

Elton

Zhang

2023

Preprint

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Background: The COVID-19 (COVID) pandemic has been associated with care seeking and delivery system changes. Before COVID the management of low back pain (LBP) was variable and a common source of low-value care. The purpose of this retrospective cohort study was to examine how the management of LBP changed during the COVID pandemic in commercially insured (CI) and Medicare Advantage (MA) cohorts. Methods: A US national sample of LBP episodes with a duration of less than 91 days experienced during 2019-2021 was analyzed. Independent variables included whether an individual had CI or MA coverage, and the timing of LBP onset. Secondary independent variables included individuals home address State. Dependent measures included the percent of individuals initially contacting eighteen types of health care provider (HCP) and receiving twenty-two types of health care services, and total episode cost. Early and late COVID measures were compared with a pre-COVID baseline to examine COVID related change. The impact of the stringency of State level COVID public policy response was evaluated. Results: The study included 222,043 CI and 466,125 MA complete episodes of LBP. During the pre-COVID period the MA cohort was older (MA median 72 vs. CI 45), with higher percent female (61% vs. 52%), and from zip codes with a higher Area Deprivation Index (median 52 vs. CI 38). MA and CI cohort attributes remained nearly identical in the early and late COVID periods. Initial contact with licensed acupuncturists (LAc risk ratio (RR) 0.66) and physical therapists (PT RR 0.82) in the CI cohort, and with PTs (RR 0.78), urgent care (RR 0.86), and emergency medicine (RR 0.87) in the MA cohort experienced the largest decreases during the early COVID period. The largest increase in the CI cohort was to PCPs (RR 1.08), and in the MA cohort to PCPs (RR 1.11) and nurse practitioners (RR 1.09). During the late COVID period the largest decreases in the CI cohort were to neurologists (RR 0.84), PTs (RR 0.86), and physical medicine and rehabilitation physicians (RR PMR 0.87) and in the MA cohort to rheumatologists (RR 0.81), PMR (RR 0.89) and pain management physicians (RR 0.89). The largest increases during the late COVID period in the CI cohort were to radiologists (RR 1.22), hospitals (RR 1.07) and orthopedic surgeons (OS RR 1.04) and in the MA cohort to LAcs (RR 1.32), radiologists (RR 1.11) and hospitals (RR 1.10). Compared to the pre-COVID period during the early COVID period the percent of episodes including most health care services was unchanged or reduced. In the late COVID period in both the CI and MA cohorts the percent of episodes with imaging studies increased, MRI (RR CI 1.15, MA 1.21), CT (RR 1.16, 1.16), and plain film radiology (RR 1.06, 1.06). The stringency of State COVID public policy responses was not associated with significant variability in either the type of HCP initially contacted, or services received for LBP. Conclusions: In both CI and MA LBP cohorts COVID was associated with changes in the types of HCP initially contacted and subsequent services provided. Guideline concordant first-line service use declined during COVID, and the rate of diagnostic imaging was higher in the late COVID period than the pre-COVID period.

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Section: (Which Was Not Certified By Peer Review)mentioning

confidence: 99%

Impact of the COVID-19 pandemic on low back pain management in commercially insured and Medicare Advantage cohorts. A retrospective cohort study

Elton

Zhang

2023

Preprint

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“…There have been no reports of the rates of VHA chiropractic care use among VHA healthcare users by sex, whereas estimated rates of use by sex for the entire US population range from 5.7-11.1% for females and 4.6-9.4% for males [15,16]. Analyses of the patient population seen in VHA chiropractic clinics have reported 15.8-17.1% are female [13,17]. While a lower percentage can be expected due to the overall sex distribution within VHA, this is in contrast with the population of US chiropractic private practice patients, of which approximately 60% are female [ 1 8, 19,20].…”

Section: Introductionmentioning

confidence: 99%

Evaluating Rates of Chiropractic Use and Utilization by Patient Sex within the United States Veterans Health Administration: A Serial Cross-Sectional Analysis

Graham

Coleman²,

Zhao³

et al. 2023

Preprint

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Background Within the United States Veterans Health Administration (VHA), the number of patients using healthcare services has increased over the past several decades. Females make up a small proportion of overall patients within the VHA; however, this proportion is growing rapidly. Previous studies have described rates of VHA chiropractic use; however, no prior study assessed differences in use of utilization rates between male and female veterans. The purpose of this study was to assess rates of use and utilization of chiropractic care by sex among VHA patients receiving care at VHA facilities with on-station chiropractic clinics.Methods A serial cross-sectional analysis of VHA national electronic health record data was conducted in Fall 2021 for fiscal year (FY) 2005–2021. The cohort population was defined as VHA facilities with on-station chiropractic clinics, and facilities were admitted to the cohort after the first FY with a minimum of 500 on-station chiropractic encounters. Variables extracted included counts of unique users of any VHA on-station facility outpatient services, unique users of VHA on-station facility chiropractic services, number of chiropractic encounters, and by sex. Use was calculated as the rate of patients of each sex receiving chiropractic services out of total patients of the same sex within each facility, and utilization was calculated as the number of chiropractic care visits by patient per FY. Linear mixed effects models were applied to examine the difference in chiropractic care utilization by sex.Results The percentage of female VHA on-station chiropractic patients increased from 11.7–17.7% from FY2005–FY2021. Among VHA facilities with on-station chiropractic care, the percentage of female VHA healthcare users who used chiropractic care (mean = 2.3%) was greater than the percentage of male VHA healthcare users who used chiropractic care (mean = 1.1%). Rates of chiropractic utilization by sex among VHA facilities with on-station chiropractic clinics were similar between males (median = 4.1 visits per year, mean = 4.6) and females (median = 4.3 visits per year, mean = 4.9).Conclusion On-station VHA chiropractic services use was higher for female patients than their male counterparts, yet overall remains low. There were no differences in chiropractic utilization rates between sexes.

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“…During the COVID-19 pandemic, there was a trend of increased telehealth use. 7 , 8 , 9 , 10 The Centers for Disease Control and Prevention studied and encouraged the use of telehealth for social distancing and continuity of care purposes. 11 However, socioeconomic and rural/urban disparities continued to predominate.…”

Section: Introductionmentioning

confidence: 99%

“… 25 , 26 , 27 Currently, the literature on chiropractic and telehealth consists of descriptive works. 8 , 28 , 29 Large-scale studies looking at which types of patients receive telehealth chiropractic care (TCC) vs others have not yet been performed. A study assessing trends in VHA chiropractic telehealth visits 8 showed an increase in telehealth use to meet the demand for continuity of care early in the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

“… 8 , 28 , 29 Large-scale studies looking at which types of patients receive telehealth chiropractic care (TCC) vs others have not yet been performed. A study assessing trends in VHA chiropractic telehealth visits 8 showed an increase in telehealth use to meet the demand for continuity of care early in the COVID-19 pandemic. However, the characteristics of patients who received care via F2F and/or telehealth have not been reported.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of Chiropractic Patients in the Veterans Health Administration During the COVID-19 Pandemic: A Cross-Sectional Analysis

Roytman

Cheung

Bathulapalli

et al. 2022

Journal of Manipulative and Physiological Therapeutics

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Changes in the Use of Telehealth and Face-To-Face Chiropractic Care in the Department of Veterans Affairs Before and After the COVID-19 Pandemic

Cited by 11 publications

References 38 publications

Impact of the COVID-19 pandemic on low back pain management in commercially insured and Medicare Advantage cohorts. A retrospective cohort study

Impact of the COVID-19 pandemic on low back pain management in commercially insured and Medicare Advantage cohorts. A retrospective cohort study

Evaluating Rates of Chiropractic Use and Utilization by Patient Sex within the United States Veterans Health Administration: A Serial Cross-Sectional Analysis

Characteristics of Chiropractic Patients in the Veterans Health Administration During the COVID-19 Pandemic: A Cross-Sectional Analysis

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