Virtual Care Expansion in the Veterans Health Administration During the COVID-19 Pandemic: Clinical Services and Patient Characteristics Associated with Utilization.

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.