ABSTRACT
RationaleThe COVID-19 pandemic has shifted care away from face to face encounters towards telephone and video telehealth. To accommodate this, the VA prioritized use of VA Video Connect (VVC) a software platform that connects providers with patients on their personal devices. As there may be factors particular to pulmonary or other specialty care clinics that are barriers or facilitators of VVC use, we wished to describe uptake of VVC in pulmonary clinics relative to a comparable specialty (cardiology) and primary care. We also sought to evaluate whether appropriate high-risk patient groups were being prioritized for VVC (e.g rural Veterans with limited access to VA services and older Veterans) to inform program development to facilitate wider expansion of this technology. MethodsWe collected data from the Veteran Health Administration Support Service Center (VSSC). We identified all encounters associated with a Pulmonary/Chest clinic location, Cardiology clinic, and Primary Care clinic. Among those encounters we identified all scheduled as VVC and sliced data by standard VA definitions of rurality. We compared use of VVC, as a proportion of total encounters, in September 2019 and September 2020 at the end of each fiscal year. As this study was hypothesis generating, we did not perform statistical testing though anticipate all differences would have been significant. Results We found that 0.02% of cardiology, 0.2% of pulmonary and 0.3% of primary care visits were conducted using VVC in 2019 and had increased to 6%, 6% and 14% respectively in 2020 (Table 1). During the pandemic, Veterans living in rural areas and highly rural were approximately half and one-quarter as likely to have a VVC encounter with a specialty clinic (cardiology or pulmonary) as Veterans in urban areas, respectively. Use of VVC was higher in primary care than specialty care clinics across rurality groups. Although use increased substantially across all age groups between 2019-20, it decreased with increasing age group across all three clinic types - with Veterans 85+y approximately half as likely to use VVC as Veterans 45-64y in both primary and specialty care. ConclusionsPrimary care use of video telehealth was higher than in specialty care clinics, potentially due to concerns about ability to examine and appropriately triage patients. Groups with limited access to hospital beds and at higher risk of severe complications of COVID infection were less likely to use VVC, suggesting targeted efforts are necessary to improve VVC use among high risk groups. .
ABSTRACT
Rationale: The field of sleep medicine has been an avid adopter of telehealth, particularly during the COVID-19 pandemic. While numerous randomized trials support the efficacy of telehealth to treat conditions such as obstructive sleep apnea (OSA) and insomnia, relatively little is known about patients' experiences and perceptions of telehealth in typical practice. Methods: We recruited a purposive sample of patients who had sleep provider encounters via one of three telehealth modalities: in-clinic video, home-based video, and telephone. We conducted semi-structured interviews to assess general telehealth experiences, elicit perceptions around most and least helpful aspects, and contrast their experiences with in-person care. Two analysts coded transcripts using content analysis. After review of coding and categorization, the analysts identified emergent themes that cut across participants and categories. Results: We conducted interviews with 35 patients (in-clinic video n=12, home-based video n=11, telephone n=12) at two VA medical centers from June 2019 to May 2020. Five themes emerged including access to care, security and privacy, personalization of care, patient empowerment, and unmet needs. 1) Access to care: Patients perceived that telehealth provided access to sleep care in a timely and convenient manner, especially during the COVID-19 pandemic. Patients also saw telehealth as a way to improve continuity of care with their preferred providers. 2) Security and Privacy: Patients described how home-based telehealth afforded them greater feelings of safety and security within appointments due to avoidance of anxiety provoking triggers (e.g. crowds). However, patients also noted a potential loss of privacy when telehealth was delivered at home. 3) Personalization of care: Patients outlined ways in which telehealth both improved and hindered their ability to communicate their individual needs to providers. In turn, this communication translated into the delivery of personalized care and positive health impacts. 4) Patient Empowerment: Patients described how telehealth empowered them to engage in self-management for their sleep disorders. 5) Unmet Needs: Patients recognized that there were specific areas where telehealth was not meeting their needs, including lack of follow-through with PAP therapy. Patients also expressed concerns around the lack of a physical examination. Conclusion: Patients described both positive and negative experiences with telehealth, highlighting areas where care can be further adapted to better suit their needs. As we continue to refine telehealth practices, we encourage providers and hospital systems to consider these aspects of the patient experience.