JAMA network open · 2026
Primary Care by Telehealth and Care Quality in the Veterans Health Administration.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Staloff Jonathan, Gunnink Eric, Rojas Jorge, Wong Edwin S, Ferguson Jacqueline M, Zulman Donna M, Nelson Karin, Reddy Ashok
Аннотация
IMPORTANCE: As telehealth (ie, telephone and video) becomes a larger component of primary care, understanding its impact on care quality is critical.
OBJECTIVE: To evaluate whether the proportion of primary care received via telehealth is associated with differences in quality-of-care outcomes among veterans who frequently use primary care.
DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective cohort study of veterans empaneled to Veterans Health Administration (VHA) primary care in fiscal years 2022 and 2023 (October 1, 2021, to September 30, 2023) with 3 or more primary care visits. Telehealth proportion categories were none (0.0% primary care visits telehealth), low (>0.0% to <28.6%), intermediate (28.6% to <50.0%), or high (≥50.0%).
EXPOSURE: Proportion of primary care delivered via telehealth.
MAIN OUTCOMES AND MEASURES: The primary outcomes were influenza vaccination, hypertension control, statin therapy and adherence, and screenings and/or counseling for depression, tobacco, and alcohol use. Multivariable logistic regression was used to estimate adjusted average marginal effects (AMEs), controlling for sociodemographic, geographic, and clinical characteristics.
RESULTS: This study included 744 599 veterans (mean [SD] age, 65 [15] years; 638 289 male [86%]). Compared with veterans receiving in-person care only, those who received a low proportion of care via telehealth had similar quality of outcomes for all cardiovascular and behavioral health measures. Influenza vaccination rates were modestly lower in the low-telehealth group vs the in-person only group (age ≥66 years, AME, -1.93% [95% CI, -2.58% to -1.29%]; age 19-65 years, AME, -1.57% [95% CI, -2.28% to -0.86%]). High telehealth users (≥50% telehealth) had the lowest adjusted likelihoods for most quality outcomes, including influenza vaccination (age ≥66 years, AME, -8.96% [95% CI, -9.84% to -8.07%]; age 19-65 years, AME, -9.72% [95% CI, -10.84% to -8.60%]) statin adherence (AME, -2.03% [95% CI -2.93% to -1.14%]) and depression screening (AME, -2.14% [95% CI, -3.20% to -1.08%]).
CONCLUSIONS AND RELEVANCE: In this cohort study of veterans with 3 or more primary care visits, primary care quality was similar for individuals who received all in-person care and those receiving low or intermediate proportions of telehealth. However, high telehealth use was associated with lower quality for several services, especially those requiring in-person interaction. Findings demonstrate the viability of hybrid telehealth and in-person models. Additional resources might be needed to ensure high-quality primary care for high proportion telehealth users.
OBJECTIVE: To evaluate whether the proportion of primary care received via telehealth is associated with differences in quality-of-care outcomes among veterans who frequently use primary care.
DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective cohort study of veterans empaneled to Veterans Health Administration (VHA) primary care in fiscal years 2022 and 2023 (October 1, 2021, to September 30, 2023) with 3 or more primary care visits. Telehealth proportion categories were none (0.0% primary care visits telehealth), low (>0.0% to <28.6%), intermediate (28.6% to <50.0%), or high (≥50.0%).
EXPOSURE: Proportion of primary care delivered via telehealth.
MAIN OUTCOMES AND MEASURES: The primary outcomes were influenza vaccination, hypertension control, statin therapy and adherence, and screenings and/or counseling for depression, tobacco, and alcohol use. Multivariable logistic regression was used to estimate adjusted average marginal effects (AMEs), controlling for sociodemographic, geographic, and clinical characteristics.
RESULTS: This study included 744 599 veterans (mean [SD] age, 65 [15] years; 638 289 male [86%]). Compared with veterans receiving in-person care only, those who received a low proportion of care via telehealth had similar quality of outcomes for all cardiovascular and behavioral health measures. Influenza vaccination rates were modestly lower in the low-telehealth group vs the in-person only group (age ≥66 years, AME, -1.93% [95% CI, -2.58% to -1.29%]; age 19-65 years, AME, -1.57% [95% CI, -2.28% to -0.86%]). High telehealth users (≥50% telehealth) had the lowest adjusted likelihoods for most quality outcomes, including influenza vaccination (age ≥66 years, AME, -8.96% [95% CI, -9.84% to -8.07%]; age 19-65 years, AME, -9.72% [95% CI, -10.84% to -8.60%]) statin adherence (AME, -2.03% [95% CI -2.93% to -1.14%]) and depression screening (AME, -2.14% [95% CI, -3.20% to -1.08%]).
CONCLUSIONS AND RELEVANCE: In this cohort study of veterans with 3 or more primary care visits, primary care quality was similar for individuals who received all in-person care and those receiving low or intermediate proportions of telehealth. However, high telehealth use was associated with lower quality for several services, especially those requiring in-person interaction. Findings demonstrate the viability of hybrid telehealth and in-person models. Additional resources might be needed to ensure high-quality primary care for high proportion telehealth users.