A New Equilibrium for Telemedicine: Prevalence of In-Person, Video-Based, and Telephone-Based Care in the Veterans Health Administration, 2019–2023
Authors: Jacqueline M. Ferguson, Charlie M. Wray, James Van Campen, Donna M. Zulman
Journal: Annals of Internal Medicine (2024)

Letters23 January 2024A New Equilibrium for Telemedicine: Prevalence of In-Person, Video-Based, and Telephone-Based Care in the Veterans Health Administration, 2019–2023Jacqueline M. Ferguson, PhD, Charlie M. Wray, DO, MS, James Van Campen, MS, Donna M. Zulman, MD, MSJacqueline M. Ferguson, PhDCenter for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CaliforniaSearch for more papers by this author, Charlie M. Wray, DO, MSDepartment of Medicine, University of California San Francisco, and Section of Hospital Medicine, Veterans Affairs San Francisco Health Care System, San Francisco, CaliforniaSearch for more papers by this author, James Van Campen, MSCenter for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CaliforniaSearch for more papers by this author, Donna M. Zulman, MD, MSCenter for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, and Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CaliforniaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-2644 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: The rapid uptake of telemedicine (that is, encounters via telephone or video) in the early phases of the COVID-19 pandemic is well documented (1–3), yet there is little published literature on the redistribution of in-person and telemedicine encounters as U.S. health care systems enter a postpandemic phase.Objective: To describe trends in clinical outpatient encounters between 1 January 2019 and 31 August 2023 that took place in person, by telephone, and by video before (before 11 March 2020), during (11 March 2020 through 10 May 2023) and after the pandemic (after 11 May 2023, defined by the end of ...References1. Heyworth L, Kirsh S, Zulman D, et al. Expanding access through virtual care: the VA’ s early experience with COVID-19. NEJM Catal Innov Care Deliv. 2020;1:1-11. doi:10.1056/CAT.20.0327 Google Scholar2. Ferguson JM, Jacobs J, Yefimova M, et al. Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization. J Am Med Informatics Assoc. 2021;28:453-462. [PMID: 33125032] doi:10.1093/jamia/ocaa284 CrossrefMedlineGoogle Scholar3. Baum A, Kaboli PJ, Schwartz MD. Reduced in-person and increased telehealth outpatient visits during the COVID-19 pandemic. Ann Intern Med. 2020;174:129-131. [PMID: 32776780] doi:10.7326/M20-3026 LinkGoogle Scholar4. Ferguson JM, Wray CM, Greene L, et al. Variation in initial and continued use of primary, mental health, and specialty video care among Veterans. Health Serv Res. 2022;58:402-414. [PMID: 36345235] doi:10.1111/1475-6773.14098 CrossrefMedlineGoogle Scholar5. Clancy C, Kirsh S. Virtual care and the pandemic: are we reaching all patients? Ann Intern Med. 2020;174:116-117. [PMID: 32776779] doi:10.7326/M20-5593 LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Jacqueline M. Ferguson, PhD; Charlie M. Wray, DO, MS; James Van Campen, MS; Donna M. Zulman, MD, MSAffiliations: Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CaliforniaDepartment of Medicine, University of California San Francisco, and Section of Hospital Medicine, Veterans Affairs San Francisco Health Care System, San Francisco, CaliforniaCenter for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, and Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CaliforniaDisclaimer: Views expressed are those of the authors and the contents do not represent the views of the U.S. Department of Veterans Affairs or the U.S. government.Acknowledgements: The authors thank Cindie Slightam, VA Office of Connected Care, and the VA Virtual Care CORE for their help in supporting this evaluation.Financial Support: This study was supported by the VA Office of Connected Care. Dr. Ferguson received funding from the Office of Connected Care as Virtual Care Associate Investigator (COR-20-199) and from a Locally Initiated Project (LIP) Award from VA Palo Alto (LIP-22-JF-1). Dr. Wray is supported by a VA Health Services Research and Development Career Development Award (IK2HX003139-01A2).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-2644.Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Ferguson (Jacqueline.Ferguson@va.gov). Data sharing: Due to U.S. Department of Veterans Affairs (VA) regulations and our ethics agreements, the analytic data sets used for this study are not permitted to leave the VA firewall without a Data Use Agreement. This limitation is consistent with other studies based on VA data. However, VA data are made freely available to researchers with an approved VA study protocol. For more information, please visit www.virec.research.va.gov or contact the VA Information Resource Center at VIReC@va.govCorresponding Author: Jacqueline M. Ferguson, PhD, Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, MDP-152, 705 Willow Road, Menlo Park, CA, 94025; e-mail, Jacqueline.Ferguson@va.gov.This article was published at Annals.org on 23 January 2024. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Latest Keywords COVID-19 Outpatients Psychiatry and mental health Telemedicine Veteran care ePublished: 23 January 2024 PDF downloadLoading ...