Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization

Abstract

Objectives To describe the shift from in-person to virtual care within Veterans Affairs (VA) during the early phase of the COVID-19 pandemic, and to identify at-risk patient populations who require greater resources to overcome access barriers to virtual care. Materials and Methods Outpatient encounters (N = 42,916,349) were categorized by care type (e.g. primary, mental health, etc.) and delivery method (e.g., in-person, video). For 5,400,878 Veterans, we used Generalized Linear models to identify patient sociodemographic and clinical characteristics associated with: 1) use of virtual (phone or video) care versus no virtual care and 2) use of video care versus no video care; between 3/11/2020 and 6/6/2020. Results By June, 58% of VA care was provided virtually compared to only 14% prior. Patients with lower income, higher disability, and more chronic conditions were more likely to receive virtual care during the pandemic. Yet, Veterans aged 45-64 and 65+ were less likely to use video care compared to those aged 18-44 (aRR 0.80 [95%CI 0.79, 0.82] and 0.50 [0.48, 0.52], respectively). Rural and homeless Veterans were 12% and 11% less likely to use video care compared to urban (0.88 [0.86, 0.90]) and non-homeless Veterans (0.89 [0.86, 0.92]). Discussion Veterans with high clinical or social need had higher likelihood of virtual service use early in the COVID-19 pandemic, however, older, homeless, and rural Veterans were less likely to have video visits, raising concerns for access barriers. Conclusions and Relevance While virtual care may expand access, access barriers must be addressed to avoid exacerbating disparities.

In-Person and Telehealth Ambulatory Contacts and Costs in a Large US Insured Cohort Before and During the COVID-19 Pandemic

“…Other recent studies have explored different aspects of COVID-19 era telehealth utilization for selected clinical conditions 32 and specific patient groups. 33 The Centers for Disease Control and Prevention 34 recently reported results relying on data furnished by a sample of telehealth companies. To the best of our knowledge, our study is the first that follows a large, well-defined continuously insured national cohort of patients to offer an assessment of individual, clinical, practitioner, payer, and geographical factors associated with changing patterns of telehealth use at the onset of the COVID-19 pandemic.…”

Differences in COVID-19 Testing and Test Positivity Among Veterans, United States, 2020

“…11 We defined priority group in this analysis by 4 categories: high-disability veterans, low-/moderate-disability veterans, low-income veterans, and veterans with no service-related disability, as defined previously. 13 We used the Charlson Comorbidity Index without age as a proxy for patient comorbidities at baseline. 14,15 We defined each condition in the Charlson Comorbidity Index using relevant International Classification of Diseases, Tenth Revision codes 16 retrieved from health care encounters from January 1, 2018, through December 31, 2019, such that all comorbidities preceded COVID-19 testing.…”

Lower Patient Anxiety and Unchanged Levels of Adherence to Hemato-Oncologic Treatment in Response to New Measures to Reduce Hospital Exposure Risk to COVID-19

“…In line with that, studies that evaluated telemedicine proposed that older and rural patients, as well as patients with lower median household incomes might face difficulties in using these high-tech technologies. 23 , 24 Furthermore, Jazieh et al reported that medical centers in lower-income countries were less likely to hold virtual tumor boards and run virtual clinics. 16 …”