Overview

This national analysis of primary care encounter types was conducted by the Veterans Health Administration (VHA) between January 5, 2020 and June 15, 2020 to determine the impact of COVID-19 on weekly trends in face-to-face and virtual visits.

Organization Name

VA Puget Sound Health Care System

Organization Type

• Integrated healthcare system/network
• Veteran's Affairs

Workflow Steps

• On March 15, 2020, VHA-guidance directed applicable primary care visits to a telemedicine infrastructure in response to COVID 19.
• The work structure of the administration includes primary health care providers and other team members (e.g. nurses, clinical associates, or social workers).
• Using previously established technology, the VHA tracked face-to-face, telephone, video, and secure messaging encounters with primary care team members.
• The authors made note of weekly trends at 1169 primary care practices from the 11 weeks prior to March 15 and the 13 weeks following it.

Outcomes

• After issuing a telemedicine directive on March 15, the VHA saw an offset of face-to-face care by an increase in virtual visits (primarily through telephone encounters completed by a member of the primary care team.)
• Overall, the percentage of virtual visits increased from 66.1% prior to March 15, to 96.8% of visits after. Prior to the mid-March directive, there were 500,544 telephone, and 6,168 video, 12,074 secure messaging visits on an average week. Afterward, there were 1,021,937 telephone, 51,144 video, and 19,015 secure message visits per week.
• Primary care provider encounters decreased while encounters completed by all other members of the primary care team increased by 75.0%

Unique Challenges

• Telephones visits may be more accessible to older veterans without access to the reliable internet or smartphones necessary for video technologies.
• The descriptive nature of the analysis prevents the authors from assessing the consequences to the quality of care by delaying and substituting face-to-face interaction. Primary care remains in the process of adapting to COVID-19.
• Provider misclassification of encounter type is possible although such error is unlikely to be systemic.

Sources

Source: Reddy A et al. A rapid mobilization of ‘virtual’ primary care services in response to COVID-19 at Veterans Health Administration. Healthcare. 2020. doi: 10.1016/j.hjdsi.2020.100464