Comparison of video-based primary care by rurality for chronic health conditions at the Veterans Health Administration

Abstract: Chronic conditions present significant concerns in rural areas due to limited access to care, despite the need for frequent follow-up visits for their management. The video-based care has the potential to improve access to care. In this study, we identified chronic conditions that were frequently managed by video visits at the Veterans Health Administration (VHA) and examined the use of video modality by rurality. It was a nationwide retrospective study of primary care visits in 2023 using the VHA electronic health records. The outcome was the use of video modality for a primary care visit. Multivariable logistic regressions were used to examine the association between the likelihood of a video visit and primary visit diagnosis, adjusting for patient-level characteristics associated with video use and clustering within patients. We examined the interaction between the rurality of the patient's residence and the visit diagnosis on video use. The sample included 4,346,777 patients and 18,861,266 primary care visits during the study period. Overall, video-based visits represented 3.9% of the total primary care visits (744,865 visits). Hypertension was the most common diagnosis in video-based care (104,038 visits), followed by diabetes (76,713), musculoskeletal pain (53,523), hyperlipidemia (30,353), and other cardiovascular diseases (24,703). For these conditions, patients living in urban areas were more likely to use video-based care for hypertension (8.3% [95% CI: 8.2–8.4] vs. 7.4% [95% CI: 7.3–7.5]), diabetes (6.0% [95% CI: 5.9–6.1] vs. 4.7% [95% CI: 4.6–4.8]), hyperlipidemia (9.4% [95% CI: 9.3–9.5] vs. 7.4% [95% CI: 7.2–7.6]), and musculoskeletal pain (8.6% [95% CI: 8.5–8.7] vs. 6.8% [95% CI: 6.7–6.9]), compared with patients living in rural areas. Our findings show that the use of video modality for chronic conditions was lower in rural areas compared to urban areas. Future research should identify ways VHA rural medical centers can improve access to video-based care, especially in the context of chronic care management.