Rates of Primary Care and Integrated Mental Health Telemedicine Visits Between Rural and Urban Veterans Affairs Beneficiaries Before and After the Onset of the COVID-19 Pandemic

Leung, Lucinda B.; Yoo, Caroline; Chu, Karen; O'Shea, Amy; Jackson, Nicholas; Heyworth, Leonie; Der‐Martirosian, Claudia

doi:10.1001/jamanetworkopen.2023.1864

Cited by 12 publications

(3 citation statements)

References 44 publications

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“…This difference remained throughout the study period. Although this finding has been previously reported by other studies examining low-income patients, 13,14 our study expands upon these findings in a larger, national network. These results have implications for measuring and optimizing the use of virtual care visits.…”

Section: Findings Indicated That the Virtual Care Visit Modality Depe...supporting

confidence: 84%

Identifying virtual care modality in electronic health record data

Larson,

Stange,

Heintzman

et al. 2024

Learning Health Systems

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BackgroundVirtual care increased dramatically during the COVID‐19 pandemic. The specific modality of virtual care (video, audio, eVisits, eConsults, and remote patient monitoring) has important implications for the accessibility and quality of care, but rates of use are relatively unknown. Methods for identifying virtual care modalities, especially in electronic health records (EHR) are inconsistent. This study (a) developed a method to identify virtual care modalities using EHR data and (b) described the distribution of these modalities over a 3‐year study period.MethodsEHR data from 316 primary care safety net clinics throughout the study period (4/1/2020‐3/31/2023) were included. Visit type (in‐person vs virtual) by adults >18 years old were classified. Expert consultation informed the development of two algorithms to classify virtual care visit modalities; these algorithms prioritized different EHR data elements. We conducted descriptive analyses comparing algorithms and the frequency of virtual care modalities.ResultsAgreement between the algorithms was 96.5% for all visits and 89.3% for virtual care visits. The majority of disagreement between the algorithms was among encounters scheduled as audio‐only but billed as a video visit. Restricting to visits where the algorithms agreed on visit modality, there were 2‐fold more audio‐only than video visits.ConclusionVisit modality classification varies depending upon which data in the EHR are prioritized. Regardless of which algorithm is utilized, safety net clinics rely on audio‐only and video visits to provide care in virtual visits. Elimination of reimbursement for audio visits may exacerbate existing inequities in care for low‐income patients.

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Section: Findings Indicated That the Virtual Care Visit Modality Depe...supporting

confidence: 84%

Identifying virtual care modality in electronic health record data

Larson,

Stange,

Heintzman

et al. 2024

Learning Health Systems

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“…Findings also reveal potential challenges to caregiver involvement in video sessions, particularly among rural populations. The most frequent barrier was poor connectivity, which aligns with evidence of difficulty with Wi-Fi and internet access in rural areas [68,69]. In addition, it is important to note that challenges integrating caregivers into patient care present in brick-and-mortar settings, such as caregivers' difficulty assisting patients with implementing care plans [70,71] or lack of knowledge about patient health conditions [72], may also be present in video visits.…”

Section: Benefits Of and Barriers To Caregiver Involvementmentioning

confidence: 88%

Caregivers’ Role in In-Home Video Telehealth: National Survey of Occupational Therapy Practitioners

Gately,

Waller,

Metcalf

et al. 2024

JMIR Rehabil Assist Technol

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Background Older adults face barriers to specialty care, such as occupational therapy (OT), and these challenges are worse for rural older adults. While in-home video telehealth may increase access to OT, older adults’ health- and technology-related challenges may necessitate caregiver assistance. Objective This study examines caregiver assistance with in-home OT video telehealth visits from the perspectives of OT practitioners at Veterans Health Administration (VHA). Methods A web-based national survey of VHA OT practitioners about caregivers’ role in video telehealth was conducted between January and February 2022. Survey items were developed with input from subject matter experts in geriatrics and OT and identified patient factors that necessitate caregiver participation; the extent to which caregivers assist with different types of tasks (technological and clinical tasks); and the perceived facilitators of, benefits of, and barriers to caregiver involvement. Results Of approximately 1787 eligible VHA OT practitioners, 286 (16% response rate) participated. Not all survey items required completion, resulting in different denominators. Most respondents were female (183/226, 81%), White (163/225, 72.4%), and occupational therapists (275/286, 96.2%). Respondents were from 87 VHA medical centers, the catchment areas of which served a patient population that was 34% rural, on average (SD 0.22). Most participants (162/232, 69.8%) had >10 years of OT experience serving a patient cohort mostly aged ≥65 years (189/232, 81.5%) in primarily outpatient rehabilitation (132/232, 56.9%). The top patient factors necessitating caregiver involvement were lack of technical skills, cognitive impairment, and advanced patient age, with health-related impairments (eg, hearing or vision loss) less frequent. Technological tasks that caregivers most frequently assisted with were holding, angling, moving, repositioning, or operating the camera (136/250, 54.4%) and enabling and operating the microphone and setting the volume (126/248, 50.8%). Clinical tasks that caregivers most frequently assisted with were providing patient history (143/239, 59.8%) and assisting with patient communication (124/240, 51.7%). The top facilitator of caregiver participation was clinician-delivered caregiver education about what to expect from video telehealth (152/275, 55.3%), whereas the top barrier was poor connectivity (80/235, 34%). Increased access to video telehealth (212/235, 90.2%) was the top-rated benefit of caregiver participation. Most respondents (164/232, 70.7%) indicated that caregivers were at least sometimes unavailable or unable to assist with video telehealth, in which case the appointment often shifted to phone. Conclusions Caregivers routinely assist VHA patients with in-home OT video visits, which is invaluable to patients who are older and have complex medical needs. Barriers to caregiver involvement include caregivers’ challenges with video telehealth or inability to assist, or lack of available caregivers. By elucidating the caregiver support role in video visits, this study provides clinicians with strategies to effectively partner with caregivers to enhance older patients’ access to video visits.

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“…As in prior work, we used VHA-specific codes corresponding to video-based primary care to identify these visits. 33 …”

Section: Methodsmentioning

confidence: 99%

Disparities in Video-Based Primary Care Use Among Veterans with Cardiovascular Disease

Tisdale,

Der-Martirosian,

Yoo

et al. 2024

J GEN INTERN MED

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Background Cardiovascular disease (CVD) is prevalent among Veterans, and video care enhances access to CVD care. However, it is unknown which patients with CVD conditions receive video care in primary care clinics, where a large proportion of CVD services is delivered. Objective Characterize use of VA video primary care for Veterans with two common CVDs, heart failure and hypertension. Design Retrospective cohort study. Patients Veterans seen in VA primary care with diagnoses of heart failure and/or hypertension in the year prior to the COVID-19 pandemic and for the first two pandemic-years. Main Measures The primary outcome was use of any video-based primary care visits. Using multilevel regressions, we examined the association between video care use and patient sociodemographic and clinical characteristics, controlling for time and adjusting for patient- and site-level clustering. Key Results Of 3.8M Veterans with 51.9M primary care visits, 456,901 Veterans had heart failure and hypertension, 50,753 had heart failure only, and 3,300,166 had hypertension only. Veterans with heart failure and hypertension had an average age of 71.6 years. 2.9% were female, and 34.8% lived in rural settings. Patients who were male, aged 75 or older, or rural-dwelling had lower odds of using video care than female patients, 18–44-year-olds, and urban-dwellers, respectively (male patients’ adjusted odds ratio [AOR] 0.73, 95% confidence interval [CI] 0.72–0.74; 75 years or older, AOR 0.38, 95% CI 0.37–0.38; rural-dwellers, AOR 0.71, 95% CI 0.70–0.71). Veterans with heart failure had higher odds of video care use than those with hypertension only (AOR 1.05, 95% CI 1.04–1.06). Conclusions Given lower odds of video primary care use among some patient groups, continued expansion of video care could make CVD services increasingly inequitable. These insights can inform equitable triage of patients, for example by identifying patients who may benefit from additional support to use virtual care.

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Rates of Primary Care and Integrated Mental Health Telemedicine Visits Between Rural and Urban Veterans Affairs Beneficiaries Before and After the Onset of the COVID-19 Pandemic

Cited by 12 publications

References 44 publications

Identifying virtual care modality in electronic health record data

Identifying virtual care modality in electronic health record data

Caregivers’ Role in In-Home Video Telehealth: National Survey of Occupational Therapy Practitioners

Disparities in Video-Based Primary Care Use Among Veterans with Cardiovascular Disease

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