4037 — Patient preference for virtual care: results from a national survey of Veterans

Lead/Presenter: Cindie Slightam,  COIN - Palo Alto
All Authors: Slightam CA (VA Palo Alto Center for Innovation to Implementation), Gregory, A (VA Palo Alto Center for Innovation to Implementation), Hu, J (VA Palo Alto Center for Innovation to Implementation, Division of Primary Care and Population Health, Stanford University School of Medicine) Jacobs, JC (VA Palo Alto Health Economics Resource Center) Gurmessa, T (VA Palo Alto Center for Innovation to Implementation) Kimerling, R (VA Palo Alto Center for Innovation to Implementation, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine) Blonigen, DM (VA Palo Alto Center for Innovation to Implementation) Zulman, DM (VA Palo Alto Center for Innovation to Implementation, Division of Primary Care and Population Health, Stanford University School of Medicine)

Objectives:
In 2016, the VA began distributing video-enabled tablets to Veterans with geographic, clinical, and social barriers to in-person care. We conducted a survey of tablet recipients to evaluate patient experiences with tablet-based virtual care, and to identify patient characteristics associated with preferences for virtual vs. in-person care.

Methods:
Between April and September 2017, we included a survey in shipments to VA-issued tablet recipients (n = 2,120 recipients) and sent a follow-up survey to respondents 3-6 months later. The baseline survey queried patients about their barriers to in-person care, and the follow-up survey queried patients about their satisfaction with the tablet and their preference for virtual vs. in-person care. We compared characteristics of respondents and non-respondents using t-tests and chi-square tests and used factor analysis to identify categories of access barriers. We used multivariate logistic regression to identify patient characteristics associated with preferences for virtual vs. in-person care.

Results:
1,294 tablet recipients responded to the baseline survey (response rate 61%), and 764 of these responded to the follow-up survey (response rate 59%). Factor analysis revealed three categories of access barriers: travel barriers, work/education/childcare commitments, and psychological/emotional discomfort with the VA care setting. 32% of respondents indicated that they prefer appointments by video, 32% in person, and 36% indicated their preference was "about the same." In multivariable logistic regression, patients were more likely to express a preference for virtual care if they experienced psychological/emotional discomfort in the VA setting (AOR 1.72, 95% CI 1.12-2.66, p < 0.05 ), were married (AOR 1.64, 95% CI 1.07-2.51, p < 0.05), and lived in a zipcode with better broadband coverage (AOR 1.03, 95% CI 1.00-1.06, p < 0.05). Patients with a greater number of chronic conditions were less likely to prefer virtual care (AOR 0.90, 0.80-1.85, p < 0.05).

Implications:
Approximately one in three VA patients who received a VA-issued tablet preferred virtual visits to in-person care.

Impacts:
Distribution of VA-issued tablets should consider factors such as psychological discomfort with the VA setting, social support, and broadband coverage to target individuals who may desire this technology and inform the development of training and resources to support those who have challenges using the tablets.