Characteristics of the Rise in Telehealth During COVID Pandemic

BACKGROUND:
During the past 20 months, COVID-19 provided the opportunity and push to increase the expansion of home-based virtual care in primary care (PC). Although the increase in telehealth and video use in PC is widely recognized, it is still unclear how the use of telehealth services in PC affects care at multiple levels (i.e., patient, provider, clinic). This study sought to examine patient, provider, and site-level characteristics of any virtual and video-based care in PC. Using VA data, investigators identified all Veterans with at least one visit to a VA primary care clinic within the VA Greater Los Angeles Healthcare System (GLA) between 2019 and 2021 (n=547,730 visits). The two main outcomes were 1) any telehealth (vs in-person), as well as 2) video-based care (vs telephone). Investigators also examined the impact of provider type and site type on telehealth or video use.

FINDINGS:

• Before the onset of COVID-19, only 14% of GLA PC patients used any telehealth services, and only 0.3% used video-based care. However, during the first 12 months of COVID-19, 63% of patients used telehealth services, and 11% used video-based care.
• Veterans at GLA community-based clinics had a higher percentage of any telehealth use (38%) compared to Veterans receiving primary care at the main West Los Angeles (WLA) medical facility (30%). Conversely, video use was lower among community-based PC patients (10%) compared to PC patients at the WLA medical facility (13%).
• Social workers, nutritionists, and pharmacists had the highest percentage of telehealth use (54%, mostly telephone) compared to primary care providers (34%), whereas mental healthcare providers were more likely to provide video-based care (43%) compared to PC clinicians (15%).
• Among all age groups except the oldest (75+), women were more likely to use telehealth or video.

IMPLICATIONS:

• Additional research is needed to identify which PC outpatient services are better suited for telephone (e.g., case management) vs video-based care (e.g., integrated mental health visits).
• It is important to understand how all clinics can systematically increase access to both telephone and video-based PC services, while ensuring equitable care for all patient populations.

LIMITATIONS:

• This study is based on only one VAMC and surrounding large and small community clinics.
• Investigators did not have access to providers’ age or comfort with telehealth, which might influence telehealth use.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (C19 20-204). Drs. Der-Martirosian and Leung are part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP).

Der-Martirosian C, Chu K, Steers WN, Wyte-Lake T, Balut MD, Dobalian A, Heyworth L, Paige NM, Leung L. Examining Telehealth Use among Primary Care Patients, Providers, and Clinics During the COVID-19 Pandemic. BMC Primary Care. June 18, 2022;23(1):155.