Patient preference for telemedicine as an alternative to in-person community care in the Veterans Health Administration

IntroductionVeterans Health Administration (VA) funding of community care (i.e., non-VA clinicians contracted by VA) aims to improve access for veterans; however, community care expenditures rose five-fold from $7.9 billion to $40 billion between fiscal years 2014 and 2024. VA telemedicine offers a convenient, high-quality alternative to some types of community care. We examined patient preferences for VA video visit versus in-person community care.MethodsThis cross-sectional study combined primary data from a national survey of patients who received both VA and community in-person care plus VA video visits (April to June 2023) with VA administrative data. We assessed the proportion of patients who preferred VA video visits versus community care in-person, and reasons for preference. We used multivariate logistic regression to identify predictors of preference.ResultsFully 44% of patients had either no preference (24%) or preferred a VA video visit (20%) over a community in-person visit in future. Top reasons for preferring a VA video visit were: convenience, avoiding infection, shorter wait times, and VA care quality, further stratified across six service areas. Two significant predictors of preference for VA video care were: (1) having a prior positive VA video visit experience (odds ratio (OR) = 2.21, 95% confidence interval (CI) = 1.55, 3.14) and (2) having a prior negative community care referral and authorization experience (OR = 2.69, 95% CI = 1.10, 6.59).DiscussionContinued support for VA providers and patients in their digital training and device access for a positive telemedicine experience could encourage many patients among the millions referred to community care to stay with VA care.