Overcoming access barriers for veterans: A cohort study of the distribution and use of VA's video-enabled tablets before and during the COVID-19 pandemic

BACKGROUND: During the COVID-19 pandemic, as health care services shifted to virtual modalities for patient and provider safety, the Veterans Affairs (VA) Office of Connected Care widely expanded its video-enabled tablet program to bridge digital divides for Veterans with limited virtual care access. OBJECTIVE: To characterize Veterans who received and used U.S. Department of Veterans Affairs (VA)-issued video-enabled tablets before versus during the COVID-19 pandemic. METHODS: We compared sociodemographic and clinical characteristics of Veterans who received VA-issued tablets during six-month pre-pandemic and pandemic periods (i.e., 3/11/2019-9/10/19 and 3/11/20-9/10/20). Then, we examined characteristics associated with video visit utilization for primary and mental health care within six months after tablet shipment, stratifying models by timing of tablet receipt. RESULTS: There was a nearly six-fold increase in the number of Veterans who received tablets in the pandemic vs pre-pandemic study periods (N= 336,107 vs 6,784, respectively). Compared to pre-pandemic, tablet recipients during the pandemic were more likely to be older (mean 64 vs. 59 years), urban-dwelling (68% vs. 56%) and have a history of housing instability (24% vs. 15%). Pandemic recipients were more likely to utilize video care (69% vs. 54%) and did so more frequently (5.6 vs. 2.3 average encounters) within six months of tablet receipt. In adjusted models, pandemic and pre-pandemic video care users were significantly more likely to be younger, stably housed, and have a mental health condition than non-users. CONCLUSIONS: Although the COVID-19 pandemic led to increased distribution of VA-issued tablets to Veterans with complex clinical and social needs, tablet recipients who were older or unstably housed remained less likely to have a video visit. The VA's tablet distribution program expanded access to video-enabled devices, but interventions are needed to bridge disparities in video visit utilization among device recipients.