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- Title
Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization.
- Authors
Ferguson, Jacqueline M; Jacobs, Josephine; Yefimova, Maria; Greene, Liberty; Heyworth, Leonie; Zulman, Donna M
- Abstract
<bold>Objectives: </bold>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.<bold>Materials and Methods: </bold>Outpatient encounters (N = 42 916 349) were categorized by care type (eg, primary, mental health, etc) and delivery method (eg, 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 March 11, 2020 and June 6, 2020.<bold>Results: </bold>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% confidence interval (CI) 0.79, 0.82] and 0.50 [95% CI 0.48, 0.52], respectively). Rural and homeless Veterans were 12% and 11% less likely to use video care compared to urban (0.88 [95% CI 0.86, 0.90]) and nonhomeless Veterans (0.89 [95% CI 0.86, 0.92]).<bold>Discussion: </bold>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.<bold>Conclusions and Relevance: </bold>While virtual care may expand access, access barriers must be addressed to avoid exacerbating disparities.
- Subjects
UNITED States. Veterans Health Administration; COVID-19 pandemic; HEALTH services administration; VETERANS' health; PANDEMICS; HOMELESS veterans; CHRONIC diseases
- Publication
Journal of the American Medical Informatics Association, 2021, Vol 28, Issue 3, p453
- ISSN
1067-5027
- Publication type
journal article
- DOI
10.1093/jamia/ocaa284