Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization.
Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization.
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DOI：
10.1093/jamia/ocaa284
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发表时间：
2021-03-01
期刊：
影响因子：
--
通讯作者：
Zulman DM
中科院分区：
文献类型：
--
作者：
Ferguson JM;Jacobs J;Yefimova M;Greene L;Heyworth L;Zulman DM
描述退伍军人事务部(VA)在新冠肺炎大流行早期阶段从面对面护理向虚拟护理的转变，并确定需要更多资源来克服获得虚拟护理障碍的高危患者群体。门诊就诊(N = 42、916和349)按护理类型(例如，初级护理、精神健康等)和交付方式(例如，面对面、视频)进行分类。对于5400至878名退伍军人，我们使用广义线性模型来确定与以下相关的患者社会人口学和临床特征：1)使用虚拟(电话或视频)护理与不使用虚拟护理；2)在2020年3月11日至2020年6月6日期间使用视频护理与不使用视频护理。截至6月份，58%的退伍军人管理局医疗服务实际上得到了提供，而之前只有14%。在大流行期间，收入较低、残疾程度较高和慢性病较多的患者更有可能接受虚拟护理。然而，与18-44岁的退伍军人相比，45-和65岁以上的退伍军人使用视频护理的可能性较小(ARR0.80[95%可信区间(CI)0.79，0.82]和0.50[95%可信区间(CI)0.48，0.52])。农村和无家可归的退伍军人使用视频护理的可能性分别比城市(0.88[95%可信区间0.86，0.90])和非无家可归退伍军人(0.89[95%可信区间0.86，0.92]低12%和11%。具有高临床或社交需求的退伍军人在新冠肺炎大流行早期使用虚拟服务的可能性较高；然而，年龄较大、无家可归的退伍军人和农村退伍军人不太可能进行视频访问，这引发了对访问障碍的担忧。虽然虚拟护理可以扩大获得机会，但必须解决获得障碍，以避免加剧不平等。
To describe the shift from in-person to virtual care within Veterans Affairs (VA) during the early phase of the COVID-19 pandemic and to identify at-risk patient populations who require greater resources to overcome access barriers to virtual care. Outpatient encounters (N = 42 916 349) were categorized by care type (eg, primary, mental health, etc) and delivery method (eg, in-person, video). For 5 400 878 Veterans, we used generalized linear models to identify patient sociodemographic and clinical characteristics associated with: 1) use of virtual (phone or video) care versus no virtual care and 2) use of video care versus no video care between March 11, 2020 and June 6, 2020. By June, 58% of VA care was provided virtually compared to only 14% prior. Patients with lower income, higher disability, and more chronic conditions were more likely to receive virtual care during the pandemic. Yet, Veterans aged 45–64 and 65+ were less likely to use video care compared to those aged 18–44 (aRR 0.80 [95% confidence interval (CI) 0.79, 0.82] and 0.50 [95% CI 0.48, 0.52], respectively). Rural and homeless Veterans were 12% and 11% less likely to use video care compared to urban (0.88 [95% CI 0.86, 0.90]) and nonhomeless Veterans (0.89 [95% CI 0.86, 0.92]). Veterans with high clinical or social need had higher likelihood of virtual service use early in the COVID-19 pandemic; however, older, homeless, and rural Veterans were less likely to have video visits, raising concerns for access barriers. While virtual care may expand access, access barriers must be addressed to avoid exacerbating disparities.
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