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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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4117 — Overcoming Obstacles: An Evaluation of Barriers to Virtual Care Use Among Recipients of VA Video-Enabled Tablets

Lead/Presenter: Charlie Wray,  San Francisco VA Medical Center
All Authors: Wray CM (San Francisco VA Medical Center), Greene AL (Palo Alto VA Medical Center, Center for Innovation to Implementation) Griffin A (Palo Alto VA Medical Center, Center for Innovation to Implementation) SooHoo S (Palo Alto VA Medical Center, Center for Innovation to Implementation) Slightam C (Palo Alto VA Medical Center, Center for Innovation to Implementation) Zulman DM (Palo Alto VA Medical Center, Center for Innovation to Implementation)

Objectives:
To describe and compare patient-reported barriers to VA Video Connect (VVC) use among Veterans who received a VA-issued tablet, based on post-tablet utilization patterns.

Methods:
We conducted a national survey of 5,451 Veterans who received a video-enabled tablet from the VA. The survey included questions about patient sociodemographics and barriers that prevented Veterans’ use of VVC. Using administrative data, survey respondents were categorized into three VVC user groups (0-, 1-, 2+visits) based on their number of VVC visits (primary care, subspecialty, mental health, and physical rehabilitation) in the 6-months after tablet receipt. We compared the reported prevalence of 16 potential barriers to using VVC (e.g., no interest, no private space, concerns about quality, etc.) across these three groups to assess if the VVC user groups reported different barriers.

Results:
Among 1,698 survey respondents (response rate = 31%), 28% (n = 473) had no VVC visits, while 16% had 1-visit (n = 271), and 56% had 2+visits (n = 954) within 6-months of tablet receipt. Individuals with 2+visits were younger, had greater broadband access, were more likely to report a college-level education, and had higher self-reported income than those with 0-visits or 1-visit. Among all respondents, the most commonly reported barriers were previous problems using VVC (35%), not knowing how to schedule a VVC visit (33%), and reporting that VVC visits were canceled/rescheduled (33%). Comparing the three utilization groups, statistically significant differences were observed across 11 of 16 barriers. The greatest differences in reported barriers between the 0-visit and 1-visit groups were with difficulty scheduling a VVC visit (51% vs. 24%), nervousness with use of VVC (36% vs. 21%), and lack of focus to use VVC (25% vs. 15%), respectively. Similarly, the greatest differences in reported barriers between the 0-visit and 2-visit groups were with difficulty scheduling a VVC visit (51% vs. 26%) and nervousness with use of VVC (36% vs. 15%), respectively.

Implications:
Despite receiving a video-enabled tablet from the VA, many Veterans still report barriers to accessing and using virtual care. Systems-based challenges (e.g., scheduling) and lack of personal comfort with VVC are common obstacles, particularly among non-users, suggesting that providing a video-enabled device is necessary but not sufficient to overcome virtual care access barriers.

Impacts:
To improve uptake and use of VVC on VA-issued devices, VA should consider interventions and implementation strategies that target specific barriers, such as support services to facilitate scheduling and training programs that build individuals’ comfort and familiarity in using VVC.