Video Telehealth Use Is More Common Among Urban Veterans

Results of a cohort study indicated that despite a wide uptake in video telehealth (VTH) use during the COVID-19 pandemic, urban veterans used this modality more, specifically veterans of American Indian and Alaska Native descent.

According to research, American Indian and Alaska Native veterans seeking mental health (MH) often are at high risk for disparities. Although Veterans Health Administration (VHA) data indicated that telehealth supported MH care during the pandemic, inequities remain unexplored.

To gather data surrounding virtual MH care inequities, researchers conducted a cohort study. This study involved comparing data between American Indian and Alaska Natives and non-American Indian and Alaska Native veterans. The study also considered whether study participants came from a rural or urban environment.

Administrative data from the VHA considered VTH use between two different times: October 1, 2019, to February 29, 2020 (pre-pandemic) and April 1 to December 31, 2020 (early pandemic).

In total, researchers included 1,754,311 veterans in the study. Of this population, 0.48 percent were rural American Indian or Alaska Native, 29.04 percent were rural non-American Indian and Alaska Native, 0.77 percent were urban American Indian or Alaska Native, and 69.71 percent were urban non-American Indian or Alaska Native.

When comparing the pre-pandemic group to the early-pandemic group, researchers noticed differences. Prior to the pandemic, urban and non-American Indian or Alaska Natives used VTH less. However, during the early pandemic, this share rose.

Researchers established several correlations related to the start of the pandemic. These consisted of urban veterans using VTH more than rural veterans, particularly those of American Indian or Alaska Native descent.

Alongside this conclusion, researchers noted that American Indian and Alaska Native veterans from rural areas could face risks related to VTH access disparities.

Prior research indicated the ways in which telehealth use rates can vary, with many factors being related to social determinants of health.

A study from September 2022 from the Office of Inspector General (OIG) indicated that Hispanic and urban Medicare beneficiaries were the most likely to use virtual care.

Researchers made this conclusion after analyzing telehealth use data from the first year of the COVID-19 pandemic. Data related to Medicare fee-for-service claims, Medicare Advantage encounters, and the Medicare Enrollment Database.

Information indicated that urban residents were more likely than rural residents to use telehealth. Also, those who were dually eligible for Medicare and Medicaid were more likely to use telehealth, as were Hispanic, younger, and female beneficiaries. Also, home settings and audio-only telehealth were common.

These findings assisted researchers in constructing recommendations to support telehealth implementation while assisting all patients. The OIG told CMS that changing from COVID-19 pandemic policies to long-term guidelines is crucial. This is largely due to their effect on treating urban residents and those using telehealth within their homes. The OIG also indicated the importance of evaluating audio-only telehealth, using a modifier, and supporting healthcare equity.

These research cases indicate that despite the usefulness of telehealth, inconsistencies often exist and require evaluation to minimize disparities.