JMIR Publications

ABSTRACT

Background:

At the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting non-urgent in-person appointments. Even though, the VA was an early adopter of telehealth in the late 1990’s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020.

Objective:

We compare telehealth services use at one VA Medical Center, Greater Los Angeles across three clinics, primary care (PC), cardiology, and home-based primary care (HBPC), 12-months before and 12-months after onset of COVID-19 (March 2020).

Methods:

We used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of the percentage of monthly telehealth visits, as well as telephone vs. VA Video Connect (VVC) visits were examined for each clinic. Semi-structured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC, during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes.

Results:

Prior to COVID-19, telehealth use varied (7%-27%), but at the onset of COVID-19, telehealth use increased substantially and reached its peak: 80% PC (April 2020), 70% cardiology, 79% HBPC (both in May 2020). Telephone was the main modality of patient choice. Several important barriers and facilitators were noted: multiple steps to use video, flexibility in using different video-capable platforms, provision of free/low-cost infrastructure (devices, internet access), scheduling and staffing considerations, technical support for patients, identifying staff telehealth champions, and developing workflows to help incorporate telehealth into treatment plans.

Conclusions:

Technological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions that improve access to care beyond the pandemic.