Telehealth Disparities and VA Video Connect - Office of Health Equity
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Telehealth Disparities and VA Video Connect

Telehealth Disparities    

Miriam Goldfarb, RN, Washington, DC VA Medical Center, Lauren Korshak, DHealth(c), MS, RCEP, Office of Health Equity, Alexandra Neuhaus-Follini, PhD, HSR&D and Office of Health Equity, Deborah Rampertaap RN, MSN – CNS, Washington, DC VA Medical Center, Dipa Sheth, MD, Section Chief, Division of Allergy and Immunology, Washington, DC VA Medical Center, Michelle Barcelo, RN, Washington, DC VA Medical Center, Laila Singh, RN, Washington, DC VA Medical Center
Telehealth Services 

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INTRODUCTION     

The Veterans Health Administration (VHA) serves a Veteran population that is increasingly racially and ethnically diverse. Equitable access to high-quality care for all Veterans is a major tenet of the VA healthcare mission. The Office of Health Equity (OHE) champions the elimination of health disparities and achieving health equity for all Veterans.

The VHA provides telehealth at more than 900 sites across the country in over 50 areas of specialty care.  Notably, evidence suggests that video treatment provided to Veterans has similar outcomes of patient satisfaction, number of sessions completed, cost and cost-effectiveness, and clinically significant outcomes such as quality of life as in-person treatment.

VA TELEHEALTH TECHNOLOGY OUTCOMES    

Telephone appointments and videoconferencing can increase access to medical care by removing barriers such as distance, time limitations and safety.  

Before the COVID-19 pandemic, Black and Hispanic Veterans were lagging behind White Veterans in terms of telehealth use. However, as the pandemic made its way across the United States, these minority groups appear to be making greater use of virtual care than White patients. It is unclear why this may be but is encouraging that there is no longer a disparity around Veterans accessing their medical appointments.


 
Percent of Encounters in Person

Percent of Encounters Virtual


REDUCING DISPARITIES AND IMPROVING ACCESS

The Office of Health Equity supports national and local efforts by VA to reduce Veteran health disparities by utilizing telehealth technology. The Washington DC VA Medical Center Allergy Clinic is quite busy - they usually have over 2000 appointments a year. To keep Veterans safe through the Covid-19 pandemic and ensure that Veterans continue to receive personalized care with face-to-face appointments, the Washington, DC Allergy Clinic harnessed the use of VA Video Connect (VVC).

VVC is a videoconferencing application designed for VA medical providers to have virtual face-to-face meetings with their patients. Veterans can use their smartphone, computer, or tablet to access the application so they can see their provider from a location where they are safe and comfortable.

A nurse calls the Veteran the day before the appointment to build rapport, verify that the Veteran received the VVC email invitation, and ask preventive screening questions. At the beginning of the VVC appointment, the nurse joins the video call to discuss any allergy concerns, questions, and asks if the Veteran needs medication refills. The nurse then relays this information to the allergist before the allergist sees the Veteran. Additionally, if, during the appointment, the allergist determines that the Veteran could benefit from additional nursing education, the allergist informs the nurse. The nurse remains in the VVC appointment after the allergist has finished to provide the additional education to the Veteran including:

  • Peak flow meter use
  • Metered dose Inhaler use
  • Spacer use
  • EpiPen indications and use
  • Nasal rinse instructions

The use of VVC has been become such a vital resource for the allergy clinic that the nurses have built their own education clinic so they can have more contact time with patients. With the education clinic, nurses plan to provide teaching outside of consultations and identify patients who would benefit from instruction reinforcement.

Overall, VVC has shown to be an effective platform to provide allergy care for Veterans who have a video capable device. Feedback from VVC appointments in the DC VA Medical Center Allergy Clinic has been positive as Veterans can save commuting time and avoid potential exposure to the coronavirus. Also, given that several major cell phone carriers have waived data charges for Veterans using VA Video Connect, there is an even greater incentive for Veterans to choose a VVC appointment.

For more information about the Office of Health Equity visit this link.

To learn more about VA telehealth, click here.