• Jonathan Staloff, Eric Gunnink, Jorge Rojas, Edwin S Wong, Karin Nelson, and Ashok Reddy.
• Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA. Jonathan.Staloff@va.gov.
• J Gen Intern Med. 2024 Sep 1; 39 (12): 224122482241-2248.

BackgroundThe Veterans Health Administration increased synchronous telemedicine (video and telephone visits) in primary care in response to the COVID-19 pandemic.ObjectiveOur objective was to determine veteran use patterns of in-person and telemedicine primary care when all modalities were available.DesignA retrospective cohort analysis. We performed a latent class analysis of primary care visits over a 1-year period to identify veteran subgroup (i.e., class) membership based on amount of primary care use and modality used. Then, we used multinomial logistic regression with a categorical outcome to identify patient characteristics associated with class identification.ParticipantsA random national sample consisting of 564,580 primary care empaneled veterans in June 2021.Main MeasuresLatent class membership.Key ResultsWe identified three latent classes: those with few primary care visits that were predominantly telephone-based (45%), intermediate number of visits of all modalities (50%), and many visits of all modalities (5%). In an adjusted model, characteristics associated with the "few" visits class, compared to the intermediate class, were older age, male sex, White race, further driving distance to primary care, higher Gagne, optimal internet speed, and unmarried status (OR 1.002, 1.52, 1.13, 1.004, 1.04, 1.05, 1.06, respectively; p < .05). Characteristics associated with membership in the "many" visits class, compared to the intermediate class, were Hispanic race, higher JEN Frailty Index and Gagne (OR 1.12, 1.11, 1.02, respectively; p < .05), and higher comorbidity by Care Assessment Need score quartile (Q2 1.73, Q3 2.80, Q4 4.12; p < 0.05).ConclusionsVeterans accessing primary care in-person or via telemedicine do so primarily in three ways: (1) few visits, predominantly telephone; (2) intermediate visits, all modalities, (3) many visits, all modalities. We found no groups of veterans receiving a majority of primary care through video.© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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