Video Telehealth Increased During COVID-19 Pandemic Among VA Pulmonary Clinics, but Barriers Remain to Reaching Similar Levels of Use as Primary Care and Among High Risk Groups

Abstract

RationaleThe COVID-19 pandemic has shifted care away from face to face encounters towards telephone and video telehealth. To accommodate this, the VA prioritized use of VA Video Connect (VVC) a software platform that connects providers with patients on their personal devices. As there may be factors particular to pulmonary or other specialty care clinics that are barriers or facilitators of VVC use, we wished to describe uptake of VVC in pulmonary clinics relative to a comparable specialty (cardiology) and primary care. We also sought to evaluate whether appropriate high-risk patient groups were being prioritized for VVC (e.g rural Veterans with limited access to VA services and older Veterans) to inform program development to facilitate wider expansion of this technology. MethodsWe collected data from the Veteran Health Administration Support Service Center (VSSC). We identified all encounters associated with a Pulmonary/Chest clinic location, Cardiology clinic, and Primary Care clinic. Among those encounters we identified all scheduled as VVC and sliced data by standard VA definitions of rurality. We compared use of VVC, as a proportion of total encounters, in September 2019 and September 2020 at the end of each fiscal year. As this study was hypothesis generating, we did not perform statistical testing though anticipate all differences would have been significant. Results We found that 0.02% of cardiology, 0.2% of pulmonary and 0.3% of primary care visits were conducted using VVC in 2019 and had increased to 6%, 6% and 14% respectively in 2020 (Table 1). During the pandemic, Veterans living in rural areas and highly rural were approximately half and one-quarter as likely to have a VVC encounter with a specialty clinic (cardiology or pulmonary) as Veterans in urban areas, respectively. Use of VVC was higher in primary care than specialty care clinics across rurality groups. Although use increased substantially across all age groups between 2019-20, it decreased with increasing age group across all three clinic types - with Veterans 85+y approximately half as likely to use VVC as Veterans 45-64y in both primary and specialty care. ConclusionsPrimary care use of video telehealth was higher than in specialty care clinics, potentially due to concerns about ability to examine and appropriately triage patients. Groups with limited access to hospital beds and at higher risk of severe complications of COVID infection were less likely to use VVC, suggesting targeted efforts are necessary to improve VVC use among high risk groups. .