PATIENT PREFERENCES FOR RECEIVING CLINICAL VIDEO TELEHEALTH VISITS AT THE VETERANS HEALTH ADMINISTRATION

ABSTRACT

STATEMENT OF PROBLEM/QUESTION There is a need to understand patients' experiences of the unprecedented expansion in telehealth services during Covid-19 at the Veterans Health Administration (VHA) to maintain its sustainability. DESCRIPTION OF PROGRAM/INTERVENTION To evaluate Veterans' experiences with clinical video telehealth visits (CVT) and its impact on preferences for future CVT utilization, we conducted a quality improvement self-administered mailed survey Veterans from New York harbor (NYH) and San Diego (SD) VHA sites, as well as interviews (N=20) with clinical providers and VHA leadership from both sites. MEASURES OF SUCCESS Provider and system-related barriers and facilitators were evaluated using interviews. Patient satisfaction and preferences for receiving CVT in comparison to in-person visits were identified. We evaluated these measures, as well as contrasted the differences from the information gathered from the survey and interviews. FINDINGS TO DATE Veterans who received at least one CVT were identified through EHR. Using standardized tools, we assessed barriers to and facilitators of use, satisfaction, and preferences for CVT utilization in comparison to in person visits in different scenarios among N=308 from NYH (53%) and SD (47%). Our sample was mostly males (83%), with half being non-Hispanic Whites (50.6%), with mean age of 62.5 years (SD = + 13.6, range= 26-88). Satisfaction CVT was high overall (8.4 on a scale from 0-10, SD= + 2.0). The proportion of Veterans reporting positive experiences with CVT was high (Range 94-98%) overall (e.g., ability to ask all needed questions, provider spending enough time, ability to communicate all health concerns). However, less Veterans (35.4 %) reported CVT preference (i.e., preferred CVT or found no difference in contrast to in person visits) compared to in person visits (64.6%). Overall, use of video calls (e.g., FaceTime) (79.9%), and having a device to access internet (97.1%) were high with no difference between groups. Veterans endorsing CVT were more likely to report intention to have future CVT for managing chronic illness (62% vs 38 %, p <.001), meeting with a specialist such as a dermatologist (41% vs 25.3%, p=0.0067), having followup care from an in person visit (90% vs 66%;p <.001), less discouraged by provider's inability to perform physical examination (15.5% vs 63.1%;p=0.0006), and reported that CVT saved time (91.8% vs 66.2%;p=0.0019). Providers viewed CVT as a complement to in-person visits;easier to schedule with less missed appointments;and easier to assess patient environment and speak with family members. Barriers included too many steps for scheduling (e.g., clerk needs to schedule and then send out links);and technological trouble shooting is not immediately accessible, often leading to switch to phone. KEY LESSONS FOR DISSEMINATION There is very high satisfaction with CVT. However, most veterans seem to prefer in person visits, which varied by reason for visit. Our mixed methods approach delineated a potential discrepancy between process of CVT and provider perceptions of CVT barriers.