Video Telehealth Use Varies for American Indian/Alaska Native Veterans

Isabelle S. Kusters, PhD, MPH

Credit: University of Houston Clear Lake

The COVID-19 pandemic brought about a rapid virtualization of mental health care across the Veterans Health Administration (VHA), facilitating care continuity for veterans. However, certain veteran groups, such as American Indian/Alaska Native veterans, have been historically at a higher risk for health inequities, including mental health care access.¹

A recent study found a significant difference in the use of video telehealth for mental health care between rural and urban populations, particularly among American Indian/Alaska Native veterans. During the early pandemic period, video telehealth use increased among all veteran groups studied.²

Results also showed urban American Indian/Alaska Native veterans, used video telehealth more than rural veterans, therefore highlighting the potential for access disparities, particularly among these residing areas.

Isabelle S. Kusters, PhD, MPH, Department of Clinical, Health, and Applied Sciences, University of Houston–Clear Lake, and investigators, aimed to examine whether there are differences in the use of video telehealth for mental health care between American Indian/Alaska Native and non-American Indian/Alaska Native veterans, focusing on rural and urban populations.

This cohort study used VHA administrative data on video telehealth use among veterans who received mental health care prepandemic between October 2019 - February 2020, and April - December 2020, for early pandemic. The main outcome was the use of video telehealth among different veteran groups based on their ethnicity (American Indian/Alaska Native or non-American Indian/Alaska Native) and their rurality.

The study included 1,754,311 veterans, with a mean age of 54.89 years (85.21% male). Among them, 0.48% were rural American Indian/Alaska Native, 29.04% were rural non-American Indian/Alaska Native, 0.77% were urban American Indian/Alaska Native, and 69.71% were urban non-American Indian/Alaska Native.

Before the pandemic, both urban (b = −0.91; P < 0.001) and non-American Indian/Alaska Native (b = −0.29; P < 0.001) veterans had lower percentages of video telehealth use compared with rural counterparts. However, during the early pandemic period, both urban (b = 1.37; P < 0.001) and non-American Indian/Alaska Native (b = 0.55; P = 0.003) veterans showed an increase in video telehealth utilization.

There was a significant interaction between rurality and American Indian/Alaska Native status during the early pandemic (b = −1.49; P < 0.001). Urban veterans, especially American Indian/Alaska Native veterans, used video telehealth more than rural veterans (non-American Indian/Alaska Native: rurality b = 1.35, P < 0.001; American Indian/Alaska Native: rurality b = 2.91, P < 0.001).

The virtualization of mental health care resulted in increased video telehealth use among all veteran groups studied. However, a significant difference was observed between rural and urban populations, particularly among the target population. This discrepancy highlights the potential for video telehealth access disparities among this population of veterans residing in rural areas.

Investigators noted concluded this cohort study sheds light on the importance of addressing geographic, socioeconomic, and infrastructural barriers to mental health care for veterans. The findings underscore the need for improved communication and collaboration between health care practitioners, organizations, and the communities they serve, particularly for vulnerable veteran populations like American Indian/Alaska Native veterans in rural areas.

References:

1. Office of Minority Health, US Department of Health and Human Services. Profile: American Indian/Alaska Native. Accessed March 10, 2023. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=62
2. Kusters IS, Amspoker AB, Frosio K, et al. Rural-Urban Disparities in Video Telehealth Use During Rapid Mental Health Care Virtualization Among American Indian/Alaska Native Veterans. JAMA Psychiatry. Published online July 26, 2023. doi:10.1001/jamapsychiatry.2023.2285