Broadband Availability Linked to Video-Based Telehealth Use Among Veterans

A study recently published in JAMA Network Open found that throughout the COVID-19 pandemic, patients from the Veterans Health Administration (VHA) who engaged in video-based telehealth the most frequently and in-person care the least often had the highest levels of broadband availability and the lowest area deprivation index (ADI).

As a result of the rapid uptake of telehealth services during the COVID-19 pandemic, healthcare delivery continues to evolve. Although virtual care provides many benefits, there are also existing disparities that prevent many patients from participating in this type of care.

In this cohort study, researchers gathered administrative data on primary care from the VHA. Gathered from visits that occurred both before (Oct. 1, 2016, to Feb. 8, 2020) and during (March 1, 2020, to June 30, 2021) the COVID-19 pandemic, the data represents 937 primary care clinics that offered both telehealth and in-person care.

Researchers used 'broadband availability' as a unit of measurement, classifying it as either inadequate, adequate, or optimal. The criteria for determining this were based on download speed and upload speed.

A total of 6.9 million veterans received primary care during the study periods. Of these, 91.8 percent were men, 71.9 percent were White, 63 percent lived in urban areas, and the patients' mean age was 63.9. Using adjusted regression analyses, researchers estimated changes in quarterly primary care visit count between the pre-and mid-pandemic periods.

The study's main finding was that patients who resided in areas with reliable broadband access had higher rates of video visits. Veterans with optimal broadband participated in 16 additional video visits per 100 patients per quarter than those with inadequate broadband.

Researchers also found that the sharpest uptake in video visit rates occurred within low ADI territories, that is, areas with fewer social disadvantages.

Based on these findings, researchers concluded that broadband availability plays a significant role in patients' use of video-based telehealth.

Further, the study noted that future research should include an evaluation of the relationship between access to telehealth and patient outcomes.

Researchers did, however, note various limitations of the study, mainly related to the lack of differentiation between visits that began on video and transitioned to telephone due to technology challenges, not accounting for the differences in telehealth demand within multiple VHA markets, and the omission of mobile telephone service coverage data when assessing broadband availability.

Various studies have pointed out how limited access and the digital divide influence patient access to telehealth and how intervention can help eliminate this issue.

For instance, a recent study showed that a quality improvement project, which included a flowchart supporting standardized workflows for video visits and a Digital Divide Consult process to connect homeless veterans to technological support, improved telehealth access for homeless veterans.