Comparing Veterans preferences and barriers for video visit utilization versus in-person visits: a survey of two VA centers

Abstract: INTRODUCTION: With the onset of COVID, the VA like other health care systems in the USA and globally had to rapidly expand their telehealth services. Prior to COVID-19, the Veterans Health Administration (VA) offered telehealth services, predominantly focused on Veterans with healthcare access barriers. There are limited studies, with mixed evidence, evaluating patients’ preferences for video visits compared with in-person visits. To address this gap, we conducted a quality improvement survey between March and August 2021 among Veterans to evaluate their experiences with video visit utilization during the first year of COVID-19. METHODS: We evaluated Veterans’ experiences with video versus in-person using six items from prior validated surveys.5 We used the national VA Corporate Data Warehouse to identify all patients who had ≥ 1 primary care clinical video visit from 3/2/2020 to 12/31/2020 at either San Diego or VA NY Harbor. We mailed 2208 unique Veterans the survey from May to October 2021 and received 493 survey responses. We excluded n = 93 surveys for never having a video visit or missing outcome variables, with a final analytical sample of N = 400, and adjusted response rate of 24.5%, with over half the sample from NY Harbor VA (n = 206, 51.5%). We categorized individuals into two preference groups based on scored responses to a 6-item survey on visit modality preference. Scores ranged from 33 to 100 (mean 50.4, SD 16.2) with higher scores indicating a preference for video visits. Video pessimists scored below-mean in video visit preference compared to in-person visits, and video enthusiasts had above-mean video visit preference compared to in-person visits. We assessed Veterans’ characteristics associated with visit preference using logistic regression. Reported barriers for video visit utilization were compared using the chi-square or Fisher’s exact test using SAS version 9.4 and p < 0.05. RESULTS: A total of 400 Veterans were surveyed. 41% preferred video compared to in-person visits. This study examined Veteran experiences with video visits during COVID-19. Less than half the sample preferred video to in-person visits, which is consistent with prior research.4 Similar to other studies, internet access was a potential disparity that influenced video telehealth preference. While concerns about confidentiality and discomfort with video utilization were main barriers early on during COVID-19,5 we found this concern in only 10% of Veterans upon conducting our survey in 2021. While inability to perform an examination remains a major concern for physicians during video visits, 4 around half of the Veterans continue to share this concern, albeit with significant variability between groups. Video pessimists were more likely to share this concern. They were also more likely to report that video visits interfered with their everyday routine, which may be due to their lower internet accessibility and comfort in use of technology. These data support the need for digital health literacy and access to technology to improve Veterans’ experiences with video telehealth. There are limitations to our study. Given its cross-sectional nature, we cannot make inferences about temporality and therefore causality. We cannot exclude the possibility of residual confounding. The analyses were based on self-reported data which are subject to misclassification, recall, and social desirability bias. Finally, our survey may not be generalizable to non-Veterans and patients from rural areas and areas outside the USA. DISCUSSION: This study presents insightful findings on Veterans’ barriers to video visit utilization by their video preference. However, further qualitative studies exploring the preferences and concerns about telemedicine should guide future care. In conclusion, for the VA to ensure convenient, accessible, and patient-centered care, they may consider accounting for patient visit modality preferences and leverage patient-physician communication in telehealth platforms to ensure patient engagement and quality of care.

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