Adoption and Sustained Use of Primary Care Video Visits Among Veterans with VA Video-Enabled Tablets.
Health care access
Tablets
Telemedicine
Veterans
Video-based care
Journal
Journal of medical systems
ISSN: 1573-689X
Titre abrégé: J Med Syst
Pays: United States
ID NLM: 7806056
Informations de publication
Date de publication:
30 Jan 2024
30 Jan 2024
Historique:
received:
20
07
2023
accepted:
16
01
2024
medline:
30
1
2024
pubmed:
30
1
2024
entrez:
30
1
2024
Statut:
epublish
Résumé
In 2020, the U.S. Department of Veterans Affairs (VA) expanded an initiative to distribute video-enabled tablets to Veterans with limited virtual care access. We examined patient characteristics associated with adoption and sustained use of video-based primary care among Veterans. We conducted a retrospective cohort study of Veterans who received VA-issued tablets between 3/11/2020-9/10/2020. We used generalized linear models to evaluate the sociodemographic and clinical factors associated with video-based primary care adoption (i.e., likelihood of having a primary care video visit) and sustained use (i.e., rate of video care) in the six months after a Veteran received a VA-issued tablet. Of the 36,077 Veterans who received a tablet, 69% had at least one video-based visit within six months, and 24% had a video-based visit in primary care. Veterans with a history of housing instability or a mental health condition, and those meeting VA enrollment criteria for low-income were significantly less likely to adopt video-based primary care. However, among Veterans who had a video visit in primary care (e.g., those with at least one video visit), older Veterans, and Veterans with a mental health condition had more sustained use (higher rate) than younger Veterans or those without a mental health condition. We found no differences in adoption of video-based primary care by rurality, age, race, ethnicity, or low/moderate disability and high disability priority groups compared to Veterans with no special enrollment category. VA's tablet initiative has supported many Veterans with complex needs in accessing primary care by video. While Veterans with certain social and clinical challenges were less likely to have a video visit, those who adopted video telehealth generally had similar or higher rates of sustained use. These patterns suggest opportunities for tailored interventions that focus on needs specific to initial uptake vs. sustained use of video care.
Identifiants
pubmed: 38289373
doi: 10.1007/s10916-024-02035-5
pii: 10.1007/s10916-024-02035-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
16Subventions
Organisme : U.S. Department of Veterans Affairs
ID : Quality Enhancement Research Initiative (QUERI) PEI 18-205
Organisme : U.S. Department of Veterans Affairs
ID : Quality Enhancement Research Initiative (QUERI) PEI 18-205
Organisme : U.S. Department of Veterans Affairs
ID : Quality Enhancement Research Initiative (QUERI) PEI 18-205
Organisme : U.S. Department of Veterans Affairs
ID : Quality Enhancement Research Initiative (QUERI) PEI 18-205
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Eruchalu CN, Pichardo MS, Bharadwaj M, Rodriguez CB, Rodriguez JA, Bergmark RW, et al. The Expanding Digital Divide: Digital Health Access Inequities during the COVID-19 Pandemic in New York City. J Urban Health. 2021;98(2):183–6. doi: https://doi.org/10.1007/s11524-020-00508-9
doi: 10.1007/s11524-020-00508-9
pubmed: 33471281
pmcid: 7816740
Zulman DM, Wong EP, Slightam C, Gregory A, Jacobs JC, Kimerling R, et al. Making connections: nationwide implementation of video telehealth tablets to address access barriers in veterans. JAMIA Open. 2019;2(3):323–9. doi: https://doi.org/10.1093/jamiaopen/ooz024
doi: 10.1093/jamiaopen/ooz024
pubmed: 32766533
pmcid: 6952023
Heyworth L, Kirsh S, Zulman D, Ferguson J, Kizer K. Expanding access through virtual care: the VA’ s early experience with Covid-19. NEJM Catal Innov Care Deliv. 2020;1(4):1–11. doi: https://doi.org/10.1056/CAT.20.0327
doi: 10.1056/CAT.20.0327
Bokolo AJ. Exploring the adoption of telemedicine and virtual software for care of outpatients during and after COVID-19 pandemic. Ir J Med Sci. 2021;190(1):1–10. doi: https://doi.org/10.1007/s11845-020-02299-z
doi: 10.1007/s11845-020-02299-z
pubmed: 32642981
Ferguson JM, Jacobs J, Yefimova M, Greene L, Heyworth L, Zulman DM. Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization. J Am Med Inform Assoc. 2021;28(3):453–62. doi: https://doi.org/10.1093/jamia/ocaa284
doi: 10.1093/jamia/ocaa284
pubmed: 33125032
Jacobs JC, Blonigen DM, Kimerling R, Slightam C, Gregory AJ, Gurmessa T, et al. Increasing Mental Health Care Access, Continuity, and Efficiency for Veterans Through Telehealth With Video Tablets. Psychiatr Serv. 2019;70(11):976–82. doi: https://doi.org/10.1176/appi.ps.201900104
doi: 10.1176/appi.ps.201900104
pubmed: 31378193
Gujral K, Van Campen J, Jacobs J, Kimerling R, Blonigen D, Zulman DM. Mental Health Service Use, Suicide Behavior, and Emergency Department Visits Among Rural US Veterans Who Received Video-Enabled Tablets During the COVID-19 Pandemic. JAMA Netw Open. 2022;5(4):e226250. doi: https://doi.org/10.1001/jamanetworkopen.2022.6250
doi: 10.1001/jamanetworkopen.2022.6250
pubmed: 35385088
pmcid: 8987904
Dhanani Z, Ferguson JM, Van Campen J, Slightam C, Jacobs JC, Heyworth L, et al. Overcoming Access Barriers for Veterans: A Cohort Study of the Distribution and Use of VA’s Video-Enabled Tablets Before and During the COVID-19 Pandemic. J Med Internet Res. 2022. doi: https://doi.org/10.2196/42563
doi: 10.2196/42563
Federal Communications Commission. Lifeline Program for Low-Income Consumers. 2020. https://www.fcc.gov/general/lifeline-program-low-income-consumers . Accessed March 15, 2023 202.
Peterson H. VA telehealth services through the Digital Divide Consult. VA News, 2022.
US Department of Veterans Affairs. 172VA10P2: VHA Corporate Data Warehouse – VA. 79 FR 4377.
World Health Organization. Coronavirus disease 2019 (COVID-19) situation report–51. World Health Organization, Geneva, Switzerland. 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10 .
Wang J, Dhanireddy P, Prince C, Larsen M, Schimpf M, Pearman G. 2021 Survey of Veteran Enrollees’ Health and Use of Health Care. 2021. https://www.va.gov/VHASTRATEGY/SOE2021/2021_Enrollee_Data_Findings_Report-508_Compliant.pdf Accessed May 28, 2022.
US Census Bureau. 2010 Census urban and rural classification and urban areas criteria. 2019. https://www.census.gov/programs-surveys/geography/guidance/geo-areas/urban-rural/2020-urban-rural.html .
Garvin LA, Hu J, Slightam C, McInnes DK, Zulman DM. Use of Video Telehealth Tablets to Increase Access for Veterans Experiencing Homelessness. J Gen Intern Med. 2021;36(8):2274–82. doi: https://doi.org/10.1007/s11606-021-06900-8
doi: 10.1007/s11606-021-06900-8
pubmed: 34027612
pmcid: 8141357
Fishman P, Von Korff M, Lozano P, Hecht J. Chronic care costs in managed care. Health Aff (Millwood). 1997;16(3):239–47. doi: https://doi.org/10.1377/hlthaff.16.3.239
doi: 10.1377/hlthaff.16.3.239
pubmed: 9141341
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee to Evaluate the Department of Veterans Affairs Mental Health Services. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington (DC): National Academies Press (US) January 31, 2018.
Ray GT, Collin F, Lieu T, Fireman B, Colby CJ, Quesenberry CP, et al. The cost of health conditions in a health maintenance organization. Med Care Res Rev. 2000;57(1):92–109. doi: https://doi.org/10.1177/107755870005700106
doi: 10.1177/107755870005700106
pubmed: 10705704
Yu W, Ravelo A, Wagner TH, Phibbs CS, Bhandari A, Chen S, et al. Prevalence and costs of chronic conditions in the VA health care system. Med Care Res Rev. 2003;60(3 Suppl):146S-67S. doi: https://doi.org/10.1177/1077558703257000
doi: 10.1177/1077558703257000
Ferguson JM, Wray CM, Jacobs J, Greene L, Wagner TH, Odden MC, et al. Variation in initial and continued use of primary, mental health, and specialty video care among Veterans. Health Serv Res. 2023;58(2):402–14. doi: https://doi.org/10.1111/1475-6773.14098
doi: 10.1111/1475-6773.14098
pubmed: 36345235
Loizos M, Baim-Lance A, Ornstein KA, Lubetsky S, Salas-Belkin L, Chavez S, et al. If You Give Them Away, It Still May Not Work: Challenges to Video Telehealth Device Use Among the Urban Homebound. J Appl Gerontol. 2023;42(9):1896–902. doi: https://doi.org/10.1177/07334648231170144
doi: 10.1177/07334648231170144
pubmed: 37070328
pmcid: 10524114
Lam K, Lu AD, Shi Y, Covinsky KE. Assessing Telemedicine Unreadiness Among Older Adults in the United States During the COVID-19 Pandemic. JAMA Intern Med. 2020;180(10):1389–91. doi: https://doi.org/10.1001/jamainternmed.2020.2671
doi: 10.1001/jamainternmed.2020.2671
pubmed: 32744593
pmcid: 7400189
Hunter I, Lockhart C, Rao V, Tootell B, Wong S. Enabling Rural Telehealth for Older Adults in Underserved Rural Communities: Focus Group Study. JMIR Form Res. 2022;6(11):e35864. doi: https://doi.org/10.2196/35864
doi: 10.2196/35864
pubmed: 36331533
pmcid: 9675008
Rush KL, Seaton CL, Corman K, Hawe N, Li EPH, Dow-Fleisner SJ, et al. Virtual Care Prior to and During COVID-19: Cross-sectional Survey of Rural and Urban Adults. JMIR Form Res. 2022;6(8):e37059. doi: https://doi.org/10.2196/37059
doi: 10.2196/37059
pubmed: 35849794
pmcid: 9400845
Kershaw K, Martelly L, Stevens C, McInnes DK, Silverman A, Byrne T, et al. Text messaging to increase patient engagement in a large health care for the homeless clinic: Results of a randomized pilot study. Digit Health. 2022;8:20552076221129729. doi: https://doi.org/10.1177/20552076221129729
doi: 10.1177/20552076221129729
pubmed: 36238754
pmcid: 9551340
Connolly SL, Stolzmann KL, Heyworth L, Weaver KR, Bauer MS, Miller CJ. Rapid Increase in Telemental Health Within the Department of Veterans Affairs During the COVID-19 Pandemic. Telemed J E Health. 2021;27(4):454–8. doi: https://doi.org/10.1089/tmj.2020.0233
doi: 10.1089/tmj.2020.0233
pubmed: 32926664
Shepherd-Banigan M, Drake C, Dietch JR, Shapiro A, Tabriz AA, Van Voorhees EE, et al. Primary Care Engagement Among Individuals with Experiences of Homelessness and Serious Mental Illness: an Evidence Map. J Gen Intern Med. 2022;37(6):1513–23. doi: https://doi.org/10.1007/s11606-021-07244-z
doi: 10.1007/s11606-021-07244-z
pubmed: 35237885
pmcid: 9085989
Viron MJ, Stern TA. The impact of serious mental illness on health and healthcare. Psychosomatics. 2010;51(6):458–65. doi: https://doi.org/10.1176/appi.psy.51.6.458
doi: 10.1176/appi.psy.51.6.458
pubmed: 21051676
Levinson Miller C, Druss BG, Dombrowski EA, Rosenheck RA. Barriers to primary medical care among patients at a community mental health center. Psychiatr Serv. 2003;54(8):1158–60. doi: https://doi.org/10.1176/appi.ps.54.8.1158
doi: 10.1176/appi.ps.54.8.1158
pubmed: 12883146
Qian AS, Schiaffino MK, Nalawade V, Aziz L, Pacheco FV, Nguyen B, et al. Disparities in telemedicine during COVID-19. Cancer Med. 2022;11(4):1192–201. doi: https://doi.org/10.1002/cam4.4518
doi: 10.1002/cam4.4518
pubmed: 34989148
pmcid: 8855911
Chang JE, Lai AY, Gupta A, Nguyen AM, Berry CA, Shelley DR. Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era. Milbank Q. 2021;99(2):340–68. doi: https://doi.org/10.1111/1468-0009.12509
doi: 10.1111/1468-0009.12509
pubmed: 34075622
pmcid: 8209855
Polinski JM, Barker T, Gagliano N, Sussman A, Brennan TA, Shrank WH. Patients’ Satisfaction with and Preference for Telehealth Visits. J Gen Intern Med. 2016;31(3):269–75. doi: https://doi.org/10.1007/s11606-015-3489-x
doi: 10.1007/s11606-015-3489-x
pubmed: 26269131
Ebinger JE, Achamallah N, Ji H, Claggett BL, Sun N, Botting P, et al. Pre-existing traits associated with Covid-19 illness severity. PLoS One. 2020;15(7):e0236240. doi: https://doi.org/10.1371/journal.pone.0236240
doi: 10.1371/journal.pone.0236240
pubmed: 32702044
pmcid: 7377468
Palaiodimos L, Kokkinidis DG, Li W, Karamanis D, Ognibene J, Arora S, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020;108:154262. doi: https://doi.org/10.1016/j.metabol.2020.154262
doi: 10.1016/j.metabol.2020.154262
pubmed: 32422233
pmcid: 7228874
Darkins A, Ryan P, Kobb R, Foster L, Edmonson E, Wakefield B, et al. Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemed J E Health. 2008;14(10):1118–26. doi: https://doi.org/10.1089/tmj.2008.0021
doi: 10.1089/tmj.2008.0021
pubmed: 19119835