Healthcare Access and Delivery During the COVID-19 Pandemic for Black Veterans with Chronic Pain: a Qualitative Study

Abstract

BACKGROUND:The COVID-19 pandemic led to significant disruptions in healthcare and rapid increases in virtual healthcare delivery. The full effects of these shifts remain unknown. Understanding effects of these disruptions is particularly relevant for patients with chronic pain, which typically requires consistent engagement in treatment to maximize benefit, and for Black patients, given documented racial disparities in pain treatment and telehealth delivery. OBJECTIVE: To understand how Black patients with chronic pain experienced pandemic-related changes in healthcare delivery. DESIGN: In-depth, semi-structured qualitative interviews PARTICIPANTS: Black veterans with chronic pain. KEY RESULTS: Participants described decreased ability to self-manage their chronic pain, obtain nonpharmacological services such as physical therapy, see their primary care providers, and schedule surgery. Most did not believe telehealth met their needs, describing feeling inadequately assessed for their pain and noting that beyond renewing prescriptions, telehealth visits were not that useful. Some believed their communication with their providers suffered from a lack of in-person contact. Others, however, were willing to accept this tradeoff to prevent possible exposure to COVID-19, and some appreciated the convenience of being able to access healthcare from home. CONCLUSIONS: Black patients with chronic pain described mostly negative effects from the shift to telecare after the pandemic's onset. Given existing disparities and likely persistence of virtual care, research on the longerterm effects of virtual pain care for Black patients is needed.

Veterans’ views of PARTNER-MH, a peer-led patient navigation intervention, to improve patient engagement in care and patient-clinician communication: A qualitative study

“…While telehealth (telephone and video conference) visit implementation significantly increased in VA settings because of the COVID-19 pandemic [ 46 - 48 ], our findings indicate that some patient subgroups may prefer and need in-person visits to successfully engage in VA health services. These results are consistent with emerging studies indicating varying levels of satisfaction and preference for telehealth visits among veterans [ 49 , 50 ]. Specifically, patients with multiple disadvantages – those with limited health and digital literacy, as well as those with restricted access to social resources – may benefit from in-person visits.…”