Characteristics of Rural Veterans Using VA Video-to-Home Telehealth or Community Care Network for Mental Healthcare.

Abstract

Objective: To compare characteristics of rural veterans using VA brick and mortar (B&M), VA video-to-home telehealth (VA VTH), or VA community care network (CCN) for mental healthcare.

Methods: Rural VA patients that received at least 2 days of mental healthcare in fiscal year 2023 were classified as B&M, VA VTH, or CCN patients based on where they received the plurality of care. Bivariate differences in characteristics were determined via SMDs. Adjusted differences in characteristics were estimated using nested dichotomies logistic regression and reported as odds ratios (factor) or predicted probabilities (continuous).

Results: The analyses demonstrate that rural VA patients (N = 177,514) using VA VTH or CCN were younger (OR = 0.77), more often female (OR = 1.64), Asian/Pacific Islander (OR = 1.27), had higher psychiatric comorbidity (OR = 1.20), had greater drive times (OR = 1.15), and lived in counties with higher county broadband coverage (OR = 1.06) compared to those using B&M VA care. Among those using VA VTH or CCN, rural black patients were less likely to use CCN (OR = 0.68).

Conclusions: Off-site modes of care like CCN and VA VTH have the potential to address long wait- and drive-times for in-person VA care that are especially pertinent for rural patients. As such, it is important to ensure that these care alternatives are being utilized by all strata of rural VA patients, and to identify differences in their use.

Relevance to clinical practice: This large retrospective cohort study provides clinicians insight into the characteristics of veterans using alternatives to on-site mental healthcare, allowing them to be better prepared to provide care to patients using those modalities.