Black Veterans with Chronic Pain Express Dissatisfaction with VA Telehealth Options during Pandemic
BACKGROUND:
The COVID-19 pandemic led to dramatic increases in the use of telehealth to deliver care. By June 2020, 58% of VA’s outpatient encounters were via phone or video, compared to 14% prior to the pandemic. The sudden decrease in in-person services, coupled with widespread, rapid implementation of telehealth, raises important questions about patients’ experiences with this shift. This study sought to understand how Black Veterans with chronic pain experienced pandemic-related changes in VA healthcare delivery. Investigators conducted qualitative interviews with Black Veterans who had completed the COOPERATE study – a randomized controlled trial of an intervention focused on communication and patient activation for Black patients with chronic pain. Telephone interviews were conducted with 21 Veterans from October 2020 through January 2021, lasting between 45 and 60 minutes. [Participants were compensated with a $30 gift card for their time.]
FINDINGS:
- Black Veterans with chronic pain described mostly negative effects from the shift to telecare after the pandemic’s onset including: decreased ability to self-manage their chronic pain; difficulty obtaining non-pharmacological services such as physical therapy; difficulty seeing their primary care providers, and trouble scheduling surgery.
- A Veteran who had been receiving healthcare in the interdisciplinary pain clinic stated that as a result of pandemic-related closures, “I literally don’t have any access to healthcare… if you don’t have the virus and don’t have an emergency sickness, then you just don’t get any service.”
- Many Veterans said phone and video visits were inadequate to handle complaints related to their pain. For example, one Veteran said, “My back went out. It was hard for me to walk, and I just got a phone call… It’s really not anything that talking on the phone would be able to handle right now.”
- Some Veterans were willing to accept the tradeoff of telehealth to avoid possible exposure to COVID-19. Others saw positive aspects to a virtual format. One Veteran said, even without in-person visits, “I know if I really need something, I’ll be taken care of.” He went on to say the video visits were productive and even “kind of fun.”
IMPLICATIONS:
- Given existing disparities and the likely persistence of virtual care, research on the longer-term effects of virtual pain care is needed. Studies should examine disparities in patient experience and patient outcomes based on race, ethnicity, gender, and other factors.
LIMITATIONS:
- Interviews were conducted during the first 10 months of the onset of the pandemic; subsequent work should focus on longer-term effects from the pandemic and the shift to telehealth.
- Due to the original study design, interviews were not conducted among Veterans from other racial/ethnic groups; thus, it is unknown whether findings would be different in these groups.
AUTHOR/FUNDING INFORMATION:
This study was funded by a COVID-specific supplement to an HSR&D study (IIR 17-032). Drs. Matthias and Eliacin are part of HSR&D’s Center for Health Information and Communication (CHIC), and Dr. Burgess is with HSR&D’s Center for Care Delivery and Outcomes Research (CCDOR).
Matthias MS, Burgess DJ, and Eliacin J. Healthcare Access and Delivery During the COVID-19 Pandemic for Black Veterans with Chronic Pain: A Qualitative Study. Journal of General Internal Medicine. November 14, 2022; online ahead of print.
