Sociodemographic patterns of provider-to-home telehealth use within the Veterans Health Administration between 2015 and 2023

TL;DR

This study examines how telehealth use in the US Veterans Health Administration changed between 2015 and 2023, focusing on differences among various demographic groups.

Contribution

The study provides new insights into how telehealth adoption varied by race, rurality, age, and disability status during and before the pandemic.

Findings

PTH video encounters increased from 3.2% to 90.7% of VHA telehealth encounters during the study period.

Urban patients, younger Veterans, and those with disabilities saw significantly higher PTH uptake during the pandemic.

Black, Asian, and multi-racial Veterans used PTH more than White Veterans during the pandemic.

Abstract

The VHA is the largest healthcare system in the US and an early adopter of telehealth. Barriers to adoption may exist among subpopulations of VHA patients.

To identify patterns in use of telehealth by modality, race, rurality, age and priority group before and during the COVID-19 pandemic.

We used data from the VHA Pyramid Analytics database to determine quarterly telehealth utilization rates from October 2015 to March 2023 using a pre-post analysis. Main measures were stratified by race, rurality, age group, and VA priority groups.

Unique patients who used any VHA care within each Fiscal Year of the study period.

N/A.

Quarterly encounters by modality and number of users with one or more Provider to Home (PTH) encounters per 1000 unique patients.

There were 36,315,299 telehealth encounters completed by 4,597,055 users during the analytic period. From October 2015–March 2020, PTH video encounters grew from 3.2% of VHA telehealth encounters to 38%. From April 2020–March 2023, PTH video encounters accounted for 90.7% of VHA telehealth encounters. Uptake of PTH during the pandemic differed significantly between demographic groups. Quarterly users per 1000 unique patients (increase relative to reference group; p-values < 0.01) increased significantly more for urban-residing patients (44.9 relative to rural); Black, Asian, or Multi-Racial patients (Black: 52.1; Asian: 48.2; multi-racial: 57.5 relative to White), younger Veterans (age < 45: 113.0; age 45–64: 80.3 relative to age ≥ 65); and Veterans with major disabilities (127.3 relative to Veterans without special considerations).

With the expansion of PTH telehealth during the pandemic, there was a shift in sociodemographic patterns among patients receiving at-home video-based care. Moving forward, VA may choose to test implementation strategies that target different demographic groups to support equitable access to PTH care.

The online version contains supplementary material available at 10.1007/s44250-025-00256-0.

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