• Lynn A Garvin, Jiaqi Hu, Cindie Slightam, D Keith McInnes, and Donna M Zulman.
• VA Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 S. Huntington Avenue, Bldg 9, Rm 225, Boston, MA, 02130, USA. Lynn.Garvin@va.gov.
• J Gen Intern Med. 2021 Aug 1; 36 (8): 227422822274-2282.

BackgroundVeterans experiencing homelessness face substantial barriers to accessing health and social services. In 2016, the Veterans Affairs (VA) healthcare system launched a unique program to distribute video-enabled tablets to Veterans with access barriers.ObjectiveEvaluate the use of VA-issued video telehealth tablets among Veterans experiencing homelessness in the VA system.DesignGuided by the RE-AIM framework, we first evaluated the adoption of tablets among Veterans experiencing homelessness and housed Veterans. We then analyzed health record and tablet utilization data to compare characteristics of both subpopulations, and used multivariable logistic regression to identify factors associated with tablet use among Veterans experiencing homelessness.PatientsIn total, 12,148 VA patients receiving tablets between October 2017 and March 2019, focusing on the 1470 VA Veterans experiencing homelessness receiving tablets (12.1%).Main MeasuresTablet use within 6 months of receipt for mental health, primary or specialty care.Key ResultsNearly half (45.9%) of Veterans experiencing homelessness who received a tablet had a video visit within 6 months of receipt, most frequently for telemental health. Tablet use was more common among Veterans experiencing homelessness who were younger (AOR = 2.77; P <.001); middle-aged (AOR = 2.28; P <.001); in rural settings (AOR = 1.46; P =.005); and those with post-traumatic stress disorder (AOR = 1.64; P <.001), and less common among those who were Black (AOR = 0.43; P <.001) and those with a substance use disorder (AOR = 0.59; P <.001) or persistent housing instability (AOR = 0.75; P = .023).ConclusionsTelehealth care and connection for vulnerable populations are particularly salient during the COVID-19 pandemic but also beyond. VA's distribution of video telehealth tablets offers healthcare access to Veterans experiencing homelessness; however, barriers remain for subpopulations. Tailored training and support for these patients may be needed to optimize telehealth tablet use and effectiveness.© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

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