Veterans’ Ambulatory Care Experience During COVID-19: Veterans’ Access to and Satisfaction with Primary Care Early in the Pandemic
Authors: Thomas Brice , Thadani Aanchal , Chen Patricia , Christie Israel , Kern Lisa M , Rajan Mangala , Kadiyala Himabindu , Helmer Drew 
Published: March 2022

Abstract
Background
The COVID-19 pandemic caused widespread practice changes to healthcare in all settings, but little is known about veterans’ experience with primary care during the early phase of the pandemic.
Objective
To characterize how COVID-induced changes affected the ambulatory care experience, specifically access and satisfaction, among Veteran users of primary care at a large urban Veterans Health Administration (VHA) medical center.
Design:
We employed a semi-structured telephone interview consisting of 56 questions to capture quantitative and qualitative data. We randomly selected potential participants from among patients who were scheduled to see any of 31 primary care physicians between March 1 – June 30, 2020 at a single location. We evaluated quantitative data using descriptive statistics and categorized open-ended qualitative responses using a matrix analysis.
Participants:
The study sample of 40 veterans largely consisted of men, almost equally split between non-Hispanic Whites and African Americans. The majority (22, 55%) of the veterans were members of Priority Group 1, the VHA eligibility group that requires either a greater than 50% disability rating or deemed unemployable. Many of the veterans had other insurance coverage, including TRICARE (21, 52.5%), Medicare (8, 20%), and private insurance (5, 12.5%).
Main Measures/Approach:
We sought to characterize veterans’ perceptions of access to and satisfaction with their primary care experience at VHA and their non-VHA primary care source. We also explored the context of veterans' daily lives during the pandemic, knowing that many people’s mental health, relationships, and employment were impacted.
Key Results:
Veterans completed (mean 2.6) more appointments than scheduled (mean 2.3) due to urgent or ‘sick’ visits with a shift to virtual modalities like telephone (mean: 2.1) and video (mean: 1.5). Those who reported decreased access to care (27, 67%) as compared to before the pandemic cited administrative barriers (15, 56%) and lack of physician availability (9, 33%) as key factors. While most veterans (31, 84%) were highly satisfied with their care, 9 (24%) reported a decrease in satisfaction since the pandemic. The few veterans who utilized non-VHA physicians were slightly more satisfied with their care. None of the veterans interviewed contracted COVID-19 during the study period, but many experienced indirect psychosocial effects such as the worsening or development of mental health conditions (6, 15%), anxiety concerning the virus (12, 30%), social isolation (8, 20%).
Conclusions
While the quantitative data suggests continued adequate access and satisfaction, the numerous comments regarding barriers to care illustrate a disconnect between veterans’ perceived experience and the quantitative findings. Given the VHA system’s efforts to scale up virtual care and pandemic-related messaging, the comments of this sample of veterans suggest that enhanced or different approaches may be warranted to maintain perceptions of access and satisfaction with primary care during times of crisis.