Veterans’ Use of Video-Based Telehealth 2,300% Higher Than Pre-Pandemic

Though audio-only telehealth utilization has largely returned to pre-pandemic levels among veterans, video-based telehealth accounts for 11 percent to 12 percent of outpatient care, a 2,300 percent jump from pre-pandemic levels, according to new research.

Published in the Annals of Internal Medicine, the study details trends in in-person, audio-only, and video-based outpatient encounters within the United States Department of Veterans Affairs (VA) healthcare system between 2019 and 2023. The authors noted that although telehealth adoption in the early phases of the COVID-19 pandemic is well-documented, little research has been done on trends in in-person and telehealth visit volumes as health systems enter a post-pandemic phase.

The researchers examined in-person, audio-only, and video-based virtual visits across three periods: before the pandemic, that is, before March 11, 2020, during the pandemic from March 11, 2020, to May 10, 2023, and after the pandemic, that is, after May 11, 2023. They identified 277 million VA clinical outpatient visits from the VA’s Corporate Data Warehouse. They characterized the visits by care service (primary care, mental health, or subspecialty care) and modality (in-person, audio-only, or video).

The study shows that the VA had, on average, 1.14 million primary care, subspecialty, or mental health visits weekly and 4.9 million visits monthly.

At the start of the pandemic, in-person visits dropped sharply, from 81 percent of all visits in February 2020 to 23 percent by May 2020. Only in January 2021 did in-person care become the dominant modality among primary care services.

In-person care volumes steadied by March 2021, and the surge in video and audio-only visits began to slow. Across all services, audio-only and video-based telehealth utilization declined from 79.6 percent of all visits in April 2020 to 36.7 percent in April 2023.

Researchers found that the decrease in audio-only visits drove the drop in telehealth use. The proportion of video visits remained close to peak levels at 11 percent to 13 percent of all visits in 2023, compared with 0.5 percent of visits pre-pandemic.  

Further, the study shows that video-based telehealth accounted for 34.5 percent of mental health, 3.7 percent of subspecialty, and 3.5 percent of primary care visits by August 2023.

However, the researchers noted that these trends “obscure disparities in access to and use of telemedicine that disproportionately affect older adults, individuals in rural regions, and patients from historically marginalized groups. Future research should consider evaluating quality, safety, and health outcomes of telemedicine in this new equilibrium.”

Research published in recent years has highlighted various social determinants of health (SDOH) factors impacting veterans’ use of video-based telehealth.

One study published in July 2023 revealed that urban veterans used video-based telehealth more during the COVID-19 pandemic than their rural peers. Researchers gathered administrative data from the VHA on video-based telehealth in a pre-pandemic period (October 1, 2019, and February 29, 2020) and an early pandemic period (April 1, 2020, and December 31, 2020). They included data on 1.75 million veterans in the study.

The researchers found that urban veterans engaged in video visits more than rural veterans, particularly those of American Indian or Alaska Native descent. Thus, they concluded that American Indian and Alaska Native veterans from rural areas could face video telehealth access disparities.

Another study noted that video-based telehealth use is heavily influenced by broadband availability. The study published in October 2022 also examined administrative data on primary care from the VHA. The data represents 937 primary care clinics offering telehealth and in-person care and spans periods before (Oct. 1, 2016, to Feb. 8, 2020) and during (March 1, 2020, to June 30, 2021) the COVID-19 pandemic.

The researchers found that veterans with optimal broadband participated in 16 additional video visits per 100 patients per quarter compared to those with inadequate broadband.