COVID-19 Pandemic Led to Telehealth Divides Among VA Beneficiaries

A recent study published in JAMA Network Open showed that telehealth use for primary and integrated mental health visits varied widely among rural and urban Veterans Affairs (VA) beneficiaries, indicating increasing telehealth divides following the start of the COVID-19 pandemic.

Although telehealth is generally seen as a beneficial tool, issues surrounding the digital divide remain, affecting access to healthcare for many. Among the populations that experience these access issues are those who live in rural areas.

In this study, researchers aimed to determine how the onset of the COVID-19 pandemic affected changes in telehealth use among rural and urban VA beneficiaries obtaining primary care for mental health integration services.

To do this, researchers conducted a cohort study, reviewing 63.5 million primary care visits among 6.3 million unique patients and 3.6 million mental health visits among over 972,578 unique patients. The data for these visits was gathered from 138 VA healthcare systems from March 16, 2019, to Dec. 15, 2021.

The researchers categorized the visits into in-person or telehealth. The mean age of the total patient population was 61.4 years; 90.5 percent were men, 17.2 percent were non-Hispanic Black patients, and 66.3 percent were non-Hispanic White patients.

Upon review of primary care services from before the pandemic, researchers found that 34 percent of rural VA healthcare systems used telehealth, higher than the 29 percent of urban VA healthcare systems that used it. But 55 percent of rural systems used telehealth following the onset of the pandemic, lower than the 60 percent of urban systems that used it.

Researchers noted that this indicated a 36 percent reduction in the odds of telehealth use in rural areas.

They also found that mental health integration highlighted a wider telehealth usage gap between rural and urban residents compared to primary care services. Before the pandemic, 29 percent of rural VA healthcare systems used telehealth compared to 35 percent of urban systems. These figures jumped to 76 percent of rural systems versus 84 percent of urban facilities.

Researchers further noted that video visits were not common among VA healthcare systems before or after the COVID-19 pandemic began.

Based on these statistics, researchers concluded that the COVID-19 pandemic increased the telehealth use divide between rural and urban patients within the VA healthcare system.

Further, to improve health equity and access, they acknowledged that the coordinated telehealth response of the VA healthcare system could benefit from managing rural disparities related to structural capacities, such as internet bandwidth. Researchers also noted that customizing technology to support adoption among rural residents could help.

Although researchers noted that using the entire VA primary care population serves is a key strength of this study, there are also limitations. These relate to the potential misclassification of rural patients, the lack of data pertaining to non-VA care among VA patients, and the applicability of the study being limited to only healthcare systems that had early telehealth infrastructure.

Last year, the Department of Veterans Affairs, Office of the Inspector General (VA-OIG) found that the VHA's digital divide consults and devices process "could have made better use of about $14.5 million in program funds with better device monitoring, retrieval controls, and oversight." The agency found that in the first three quarters of 2021, VHA provided 41,000 patients with devices. But only 49 percent completed a VA Video Connect (VVC) appointment.

Last October, speakers at Xtelligent Healthcare Media's 3rd Annual Connected Health Virtual Summit discussed various strategies to reduce the digital divide and expand access to connected care.

Defined as the inequalities between those with and without access to technology, the digital divide can lead to issues in care access. According to healthcare facility leaders, extraction and review of utilization data are necessary to combat the digital divide.

They also emphasized the importance of selecting the right technology to broaden access and improve health equity.