A recent study has found that despite the return of audio-only telehealth utilization among veterans to pre-pandemic levels, there has been a large increase in video-based telehealth, now comprising 11 to 12 percent of outpatient care. This increase represents a remarkable 2,300 percent jump from pre-pandemic levels, highlighting a change in telehealth modalities within the veteran community. Spanning from January 2019 to August 2023, the research meticulously scrutinized the evolving patterns of in-person, telephone, and video encounters across primary care, mental health, and subspecialty care services. The study takes place during the widespread adoption of telehealth during the COVID-19 pandemic, key for understanding healthcare delivery changes.
This comprehensive study analyzed a massive dataset, including 277,348,286 VA clinical outpatient encounters. The study focused on an open cohort of 9 million veterans, offering a broad view of healthcare utilization within this diverse demographic. Among the enrolled veterans, a predominant 91% identified as men, with 72% being of White ethnicity, and 65% residing in urban areas. Demographic details contextualize the study’s findings, offering a comprehensive understanding of the study population. Categorizing encounters by care service and modality (in-person, telephone, and video) serves as the methodological basis for a detailed analysis of healthcare delivery.
The study aimed to understand how healthcare encounters changed over time during and after the pandemic. The initial observations highlighted a large decline in in-person encounters across all services, a trend that persisted until March 2021. This decrease in traditional in-person care was accompanied by a compensatory surge in telephone- and video-based encounters, with telephone-based care emerging as the dominant modality. The change in care methods was particularly noticeable in primary care and mental health services, emphasizing how telehealth effectively replaced traditional in-person interactions during the peak of the pandemic. In the following months, there was a changing mix of healthcare methods, and by January 2021, in-person care had become more prominent in primary care services. This fluctuation over time highlights the healthcare system’s ability to adapt to the evolving dynamics of the pandemic, vaccine distribution, and shifting patient requirements. Telehealth, particularly video visits, was key in compensating for the reduced reliance on traditional in-person care. The detailed patterns revealed in this time analysis offer valuable insights into how healthcare delivery is evolving within the VA health care system.
Despite the overall stabilization of telehealth rates around May 2021, the study revealed persistent changes in telehealth utilization. Telephone visits continued to decline across all services, indicating a sustained preference for more interactive and visually oriented telehealth modalities. At the same time, there was a consistent increase in mental health video visits, showing that mental health services gained a strong presence in the virtual space. This thorough analysis of telehealth trends clarifies the complex interaction of patient preferences, technological infrastructure, and the evolving nature of healthcare delivery. The study also brings attention to a transformation in the use of video-based care. By August 2023, video-based encounters represented 34.5% of mental health, 3.7% of subspecialty, and 3.5% of primary care encounters, representing a remarkable 2,300% increase from the pre-pandemic level of 0.5%. This change emphasizes the enduring influence of the pandemic on healthcare delivery preferences, with video-based care establishing a prominent presence in the post-pandemic healthcare sector.
The study concludes by scrutinizing the implications of its findings for the VA health care system and providing a roadmap for future research. A new balance has been established, where telephone-based care has largely reverted to pre-pandemic levels, and simultaneously, video-based care constitutes a notable 11% to 12% of outpatient care. The sustained reliance on video-based care, especially in mental health services, suggests a lasting acceptance and integration of telehealth into routine healthcare delivery. The researchers emphasize the need for future research to explore the quality, safety, and health outcomes of telemedicine in this new equilibrium. The study also emphasizes the importance of considering potential disparities in access to and use of telemedicine, particularly among older adults, individuals in rural regions, and historically marginalized groups. These discussions and future research considerations provide a comprehensive framework for understanding the broader implications of the study’s findings on telehealth within the VA health care system and beyond.
