New research found that urban veterans, particularly those of American Indian or Alaska Native descent, were more likely to use video telehealth during the COVID-19 pandemic. Prior disparities in mental health care for American Indian and Alaska Native veterans persisted despite telehealth support. Another study revealed higher telehealth usage among Hispanic and urban Medicare beneficiaries during the pandemic. Recommendations were made to ensure equitable access and address disparities in telehealth implementation.
Urban veterans, particularly those of American Indian or Alaska Native descent, were found to be more inclined to use video telehealth, according to recent research. The study, conducted during the COVID-19 pandemic, revealed a significant uptake in video telehealth use among veterans. However, the usage was more pronounced among urban veterans, particularly those from American Indian or Alaska Native backgrounds, who sought mental health care.
It is worth noting that American Indian and Alaska Native veterans often face disparities in mental health care, as suggested by previous Veterans Health Administration (VHA) data. Despite the support provided by telehealth during the pandemic, these disparities remained unexplored.
To delve into the inequities in virtual mental health care, researchers conducted a cohort study, comparing data between American Indian and Alaska Native veterans and non-American Indian and Alaska Native veterans. The study also analyzed whether participants came from rural or urban environments.
The research used administrative data from the VHA, comparing video telehealth use before the pandemic (October 1, 2019, to February 29, 2020) and during the early pandemic (April 1 to December 31, 2020).
The study encompassed 1,754,311 veterans, with a breakdown of 0.48 percent being rural American Indian or Alaska Native, 29.04 percent rural non-American Indian or Alaska Native, 0.77 percent urban American Indian or Alaska Native, and 69.71 percent urban non-American Indian or Alaska Native.
Comparing the pre-pandemic and early-pandemic periods, researchers observed shifts in video telehealth usage. Before the pandemic, urban and non-American Indian or Alaska Native veterans used video telehealth less frequently, but during the early pandemic, this trend changed.
Moreover, the study revealed several correlations at the beginning of the pandemic, including higher video telehealth use among urban veterans, especially those of American Indian or Alaska Native descent. Researchers also highlighted that American Indian and Alaska Native veterans from rural areas might face disparities in accessing video telehealth.
Earlier research has also shown that telehealth usage rates can vary significantly based on social determinants of health. A September 2022 study by the Office of Inspector General (OIG) found that Hispanic and urban Medicare beneficiaries were the most likely to use virtual care during the first year of the COVID-19 pandemic. The study analyzed data from Medicare fee-for-service claims, Medicare Advantage encounters, and the Medicare Enrollment Database. It revealed that urban residents and those dually eligible for Medicare and Medicaid were more likely to use telehealth. Additionally, factors such as ethnicity, age, gender, home settings, and audio-only telehealth contributed to telehealth utilization.
Based on these findings, researchers have proposed recommendations to support telehealth implementation and ensure equitable access for all patients. The OIG stressed the importance of transitioning from pandemic policies to long-term guidelines, particularly in serving urban residents and those relying on telehealth within their homes. They also emphasized evaluating audio-only telehealth, using a modifier, and promoting healthcare equity.
Overall, while telehealth has proven useful, it is crucial to address inconsistencies and disparities to enhance its effectiveness in healthcare delivery.