Expansion of telemedicine during COVID-19 at a VA specialty clinic

Background: COVID-19 rapidly accelerated the implementation of telemedicine in U.S. Department of Veterans Affairs (VA) specialty care clinics. This mixed-methods study was conducted at a VA medical center to understand the use of telemedicine, and the barriers and facilitators to its implementation, in cardiology outpatient clinics. Methods: Quantitative analyses modeled monthly trends of telemedicine use over 24-months (March 2019-March 2021) with segmented logistic regression and adjusted for socio-demographic predictors of patient-level telemedicine use. Qualitative interviews were conducted (July-October 2020) with eight cardiology clinicians. Results: At the onset of COVID-19, likelihood of telemedicine use was similar to 12 times higher than it was pre-COVID-19 (p<.001). White (OR=1.38, 95% CI:1.23-1.54), married (OR=1.25, 95% CI:1.11-1.40), Veterans with other health insurance (OR=1.19, 95% CI:1.06-1.35), were more likely to use telemedicine. Veterans with higher health risk factors were less likely (OR=0.95, 95% CI:0.93-0.97). Facilitators to rapid expansion of telemedicine included prior telemedicine experience; provider trainings; and staff champions. In contrast, lack of technical support and scheduling grids for virtual visits and patient ability/preference served as barriers. Conclusions: Findings suggest that once mutable barriers were addressed, the medical center was able to expand its telemedicine efforts during COVID-19. Beyond the pandemic, a hybrid of virtual and face-to-face care might be feasible and likely beneficial for healthcare providers and patients in specialty care.