A rapid mobilization of ‘virtual’ primary care services in response to COVID-19 at Veterans Health Administration

Reddy, Ashok; Gunnink, Eric; Deeds, Stefanie; Hagan, Scott; Heyworth, Leonie; Mattras, Thomas F.; Nelson, Karin M.

doi:10.1016/j.hjdsi.2020.100464

Cited by 40 publications

(45 citation statements)

References 6 publications

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“…Staff were redeployed to primary care offices. The electronic health record (EHR) technical teams completed all configurations, templates and phrases, billing and coding changes, and technical set-up for televisits in a few weeks, similar to experiences elsewhere in USA [ 59 – 63 ]. Use of telehealth increased rapidly to a peak of c. 62% outpatient encounters ( Figure 5 ).…”

Section: Results: Pci Response To Covid-19mentioning

confidence: 99%

“…The few reports regarding implementation of telehealth systems in response to the COVID-19 pandemic come from large centers similar to Geisinger, including the University of California, San Diego [ 64 ], the Veterans Administration [ 59 , 60 ], Boston’s Children’s Hospital [ 65 ], and a few private practices as part of larger academic medical centers [ 66 ]. However, it must be noted that the Geisinger experience may not represent the experience across the USA, even for similar sized integrated health systems.…”

Section: Results: Pci Response To Covid-19mentioning

confidence: 99%

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Primary Care Informatics Response to Covid-19 Pandemic: Adaptation, Progress, and Lessons from Four Countries with High ICT Development

et al. 2021

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Objective: Internationally, primary care practice had to transform in response to the COVID pandemic. Informatics issues included access, privacy, and security, as well as patient concerns of equity, safety, quality, and trust. This paper describes progress and lessons learned. Methods: IMIA Primary Care Informatics Working Group members from Australia, Canada, United Kingdom and United States developed a standardised template for collection of information. The template guided a rapid literature review. We also included experiential learning from primary care and public health perspectives. Results: All countries responded rapidly. Common themes included rapid reductions then transformation to virtual visits, pausing of non-COVID related informatics projects, all against a background of non-standardized digital development and disparate territory or state regulations and guidance. Common barriers in these four and in less-resourced countries included disparities in internet access and availability including bandwidth limitations when internet access was available, initial lack of coding standards, and fears of primary care clinicians that patients were delaying care despite the availability of televisits. Conclusions: Primary care clinicians were able to respond to the COVID crisis through telehealth and electronic record enabled change. However, the lack of coordinated national strategies and regulation, assurance of financial viability, and working in silos remained limitations. The potential for primary care informatics to transform current practice was highlighted. More research is needed to confirm preliminary observations and trends noted.

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Section: Results: Pci Response To Covid-19mentioning

confidence: 99%

Section: Results: Pci Response To Covid-19mentioning

confidence: 99%

Primary Care Informatics Response to Covid-19 Pandemic: Adaptation, Progress, and Lessons from Four Countries with High ICT Development

et al. 2021

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“…In these early months of the pandemic, politicians, policymakers, and the lay press across different countries and regions all emphasized the role of new modalities such as video and e-consultations in this unprecedented service change [29][30][31][32][33]. But despite this focus on the novel, the reality in most countries was that most remote consultations-especially in primary care-occurred using the old-fashioned telephone [34][35][36][37][38].…”

Section: Introductionmentioning

confidence: 99%

Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study

Wherton¹,

Greenhalgh²,

Shaw³

2021

J Med Internet Res

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Background Scotland—a country of 5.5 million people—has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care program. A strategy to develop a nationwide video consultation service began in 2017. Our mixed methods evaluation was commissioned in mid-2019 and extended to cover the pandemic response in 2020. Objective To draw lessons from a national evaluation of the introduction, spread, and scale-up of Scotland’s video consultation services both before and during the pandemic. Methods Data sources comprised 223 interviews (with patients, staff, technology providers, and policymakers), 60 hours of ethnographic observation (including in-person visits to remote settings), patient and staff satisfaction surveys (n=20,349), professional and public engagement questionnaires (n=5400), uptake statistics, and local and national documents. Fieldwork during the pandemic was of necessity conducted remotely. Data were analyzed thematically and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework which considers multiple influences interacting dynamically and unfolding over time. Results By the time the pandemic hit, there had been considerable investment in material and technological infrastructure, staff training, and professional and public engagement. Scotland was thus uniquely well placed to expand its video consultation services at pace and scale. Within 4 months (March-June 2020), the number of video consultations increased from about 330 to 17,000 per week nationally. While not everything went smoothly, video was used for a much wider range of clinical problems, vastly extending the prepandemic focus on outpatient monitoring of chronic stable conditions. The technology was generally considered dependable and easy to use. In most cases (14,677/18,817, 78%), patients reported no technical problems during their postconsultation survey. Health care organizations’ general innovativeness and digital maturity had a strong bearing on their ability to introduce, routinize, and expand video consultation services. Conclusions The national-level groundwork before the pandemic allowed many services to rapidly extend the use of video consultations during the pandemic, supported by a strong strategic vision, a well-resourced quality improvement model, dependable technology, and multiple opportunities for staff to try out the video option. Scotland provides an important national case study from which other countries may learn.

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“…The VA benefits from one of the most highly developed health information systems in the world [ 1 ] and is one of the first US healthcare systems to create extensive virtual healthcare infrastructure including telephone and video visits (henceforth referred to as “virtual”) [ 2 , 3 ]. With the emergence of the COVID‐19 pandemic, changes in healthcare delivery became immediately necessary [ 4 , 5 ], and the VA responded quickly by expanding virtual care [ 2 , 6 , 7 , 8 , 9 , 10 ]. On 19 March 2020, the VA issued guidance for “Alternative Telehealth Communication Technologies During COVID19 National Emergency” [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

HIV care using differentiated service delivery during the COVID‐19 pandemic: a nationwide cohort study in the US Department of Veterans Affairs

et al. 2021

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IntroductionThe Department of Veterans Affairs (VA) is the largest provider of HIV care in the United States. Changes in healthcare delivery became necessary with the COVID‐19 pandemic. We compared HIV healthcare delivery during the first year of the COVID‐19 pandemic to a prior similar calendar period.MethodsWe included 27,674 people with HIV (PWH) enrolled in the Veterans Aging Cohort Study prior to 1 March 2019, with ≥1 healthcare encounter from 1 March 2019 to 29 February 2020 (2019) and/or 1 March 2020 to 28 February 2021 (2020). We counted monthly general medicine/infectious disease (GM/ID) clinic visits and HIV‐1 RNA viral load (VL) tests. We determined the percentage with ≥1 clinic visit (in‐person vs. telephone/video [virtual]) and ≥1 VL test (detectable vs. suppressed) for 2019 and 2020. Using pharmacy records, we summarized antiretroviral (ARV) medication refill length (<90 vs. ≥90 days) and monthly ARV coverage.ResultsMost patients had ≥1 GM/ID visit in 2019 (96%) and 2020 (95%). For 2019, 27% of visits were virtual compared to 64% in 2020. In 2019, 82% had VL measured compared to 74% in 2020. Of those with VL measured, 92% and 91% had suppressed VL in 2019 and 2020. ARV refills for ≥90 days increased from 39% in 2019 to 51% in 2020. ARV coverage was similar for all months of 2019 and 2020 ranging from 76% to 80% except for March 2019 (72%). Women were less likely than men to be on ARVs or to have a VL test in both years.ConclusionsDuring the COVID‐19 pandemic, the VA increased the use of virtual visits and longer ARV refills, while maintaining a high percentage of patients with suppressed VL among those with VL measured. Despite decreased in‐person services during the pandemic, access to ARVs was not disrupted. More follow‐up time is needed to determine whether overall health was impacted by the use of differentiated service delivery and to evaluate whether a long‐term shift to increased virtual healthcare could be beneficial, particularly for PWH in rural areas or with transportation barriers. Programmes to increase ARV use and VL testing for women are needed.

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A rapid mobilization of ‘virtual’ primary care services in response to COVID-19 at Veterans Health Administration

Cited by 40 publications

References 6 publications

Primary Care Informatics Response to Covid-19 Pandemic: Adaptation, Progress, and Lessons from Four Countries with High ICT Development

Primary Care Informatics Response to Covid-19 Pandemic: Adaptation, Progress, and Lessons from Four Countries with High ICT Development

Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study

HIV care using differentiated service delivery during the COVID‐19 pandemic: a nationwide cohort study in the US Department of Veterans Affairs

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