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Adoption and Sustained Use of Primary Care Video Visits Among Veterans with VA Video-Enabled Tablets

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Abstract

In 2020, the U.S. Department of Veterans Affairs (VA) expanded an initiative to distribute video-enabled tablets to Veterans with limited virtual care access. We examined patient characteristics associated with adoption and sustained use of video-based primary care among Veterans. We conducted a retrospective cohort study of Veterans who received VA-issued tablets between 3/11/2020-9/10/2020. We used generalized linear models to evaluate the sociodemographic and clinical factors associated with video-based primary care adoption (i.e., likelihood of having a primary care video visit) and sustained use (i.e., rate of video care) in the six months after a Veteran received a VA-issued tablet. Of the 36,077 Veterans who received a tablet, 69% had at least one video-based visit within six months, and 24% had a video-based visit in primary care. Veterans with a history of housing instability or a mental health condition, and those meeting VA enrollment criteria for low-income were significantly less likely to adopt video-based primary care. However, among Veterans who had a video visit in primary care (e.g., those with at least one video visit), older Veterans, and Veterans with a mental health condition had more sustained use (higher rate) than younger Veterans or those without a mental health condition. We found no differences in adoption of video-based primary care by rurality, age, race, ethnicity, or low/moderate disability and high disability priority groups compared to Veterans with no special enrollment category. VA’s tablet initiative has supported many Veterans with complex needs in accessing primary care by video. While Veterans with certain social and clinical challenges were less likely to have a video visit, those who adopted video telehealth generally had similar or higher rates of sustained use. These patterns suggest opportunities for tailored interventions that focus on needs specific to initial uptake vs. sustained use of video care.

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Acknowledgements

The authors thank Camila Chaudhary, VA Office of Connected Care, VA Office of Rural Health, the Virtual Access QUERI team, and Stanford School of Medicine Department of Health Policy for their help in supporting this evaluation.

Funding

Funding was also provided by the U.S. Department of Veterans Affairs (VA) Office of Rural Health. Visit www.ruralhealth.va.gov to learn more. This work was also supported by a VA Quality Enhancement Research Initiative (QUERI) PEI 18–205. Dr. Ferguson was directly supported by a VA QUERI Initiative to Advance Diversity in Implementation Leadership (ADIL) Supplement to the QUERI PEI-18-205.

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Authors and Affiliations

  1. Department of Health Policy, Stanford University School of Medicine, 290 Campus Dr, Stanford, CA, 94305, USA

    Zainub Dhanani

  2. Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA

    Jacqueline M. Ferguson, James Van Campen, Cindie Slightam & Donna M. Zulman

  3. Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA

    Jacqueline M. Ferguson & Donna M. Zulman

  4. Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, Washington, DC, USA

    Leonie Heyworth

  5. Department of Medicine, UC San Diego School of Medicine, San Diego, CA, USA

    Leonie Heyworth

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  1. Zainub Dhanani
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Contributions

Conceptualization: Zainub Dhanani, Jaqueline M. Ferguson, James Van Campen, Cindie Slightam, Leonie Heyworth, Donna M. Zulman. Data curation: James Van Campen. Formal analysis: Zainub Dhanani, Jaqueline M. Ferguson Funding Acquisition: Leonie Heyworth, Donna M. Zulman. Methodology: Zainub Dhanani, Jaqueline M. Ferguson, Donna M. Zulman. Visualization: Zainub Dhanani, Jaqueline M. Ferguson. Project administration: Cindie Slightam, Donna M. Zulman. Writing-original draft: Zainub Dhanani. Writing-review and editing: Zainub Dhanani, Jaqueline M. Ferguson, Cindie Slightam, James Van Campen, Leonie Heyworth, Donna M. Zulman.

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Correspondence to Zainub Dhanani.

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The authors have no competing interests to declare that are relevant to the content of this article.

Disclaimer

Views expressed are those of the authors and the contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

Data Sharing Statement

Due to US Department of Veterans Affairs (VA) regulations and our ethics agreements, the analytic data sets used for this study are not permitted to leave VA’s firewall without a Data Use Agreement. This limitation is consistent with other studies based on VA data. However, VA data are made freely available to researchers with an approved VA study protocol. For more information, please visit https://www.virec.research.va.gov or contact VA’s Information Resource Center at VIReC@va.gov.

Ethical Approval

This evaluation was completed as part of a VA Quality Enhancement Research Initiative and was designated as non-research quality improvement by VA’s Office of Rural Health.

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Dhanani, Z., Ferguson, J.M., Van Campen, J. et al. Adoption and Sustained Use of Primary Care Video Visits Among Veterans with VA Video-Enabled Tablets. J Med Syst 48, 16 (2024). https://doi.org/10.1007/s10916-024-02035-5

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