Use of Real Time Clinical Video Telehealth to Home by primary care providers within the Veterans Health Administration during the first wave of the COVID-19 pandemic: variability across VA stations and with time

Objective: Determine the extent to which use of Clinical Video Telehealth to Home (VT2H) for primary care licensed independent practitioner visits (PCLIPVs) varied over time and across the Veterans Health Administration (VA) during the first 18 months of the COVID pandemic, and if there was an association between VT2H usage and VA station characteristics. Materials and Methods: All outpatient encounters (n = 12 143 456) for Veterans (n = 4 373 638) that had VA PCLIPVs during the period of observation were categorized as conducted by VT2H, in-person, or telephone. The change over time in the percentage of total PCLIPVs conducted by VT2H was plotted and associations between VA station characteristics and VT2H usage were analyzed using simple statistics and negative binomial regression. Results: Between March 2020 and mid-August 2020, VT2H visits increased from <2% to 13% of all VA PCLIPVs. However, VT2H usage varied substantively by VA station and declined system-wide to <9% of PCLIPVs by July 2021. VA stations that serve a greater proportion of rural Veterans were found less likely to use VT2H. Discussion: The VA was successful in increasing the use of VT2H for PCLIPVs during the first phase of the COVID pandemic. However, VT2H usage varied by VA station and over time. Beyond rurality, it is unknown what station characteristics may be responsible for the variance in VT2H use. Conclusion: Future investigation is warranted to identify the unique practices employed by VA stations that were most successful in using VT2H for PCLIPVs and whether they can be effectively disseminated to other stations. LAY SUMMARY Before the COVID pandemic started in March 2020, fewer than 2% of primary care visits across the VA healthcare system (VA) were conducted using video telehealth (VT). During the first phase of the pandemic, the VA was successful in increasing the use of VT. By August 2020, over 13% of primary care visits were completed using VT. However, this varied from one VA medical center to another. In addition, the percentage of primary care visits conducted by VT declined system-wide by July 2021. We found that VA medical centers with a high number of rural Veterans were less likely to use VT. However, there were probably many other unknown factors that also contributed to the large differences in VT usage between VA centers. Future studies are needed to identify the unique practices employed by VA healthcare centers that were most successful in using VT. It would also be important to determine whether these practices can be used effectively by other VA sites.