b'Telemedicine Increase During PandemicPut Spotlight on Possible DisparitiesDespite its leadership role in the use of virtual healthcare to improve care delivery, the VA continues to grapple with a problem that plagues many technology-based advances: accessibility. Telemedicine is not uniformly available to veterans. Especially impacted are those with low incomes, unstable housing and of American Indian/Alaska native lineage.By Mary Anne DunkinPALO ALTO, CAThe VA has long been a leaderassociate investigator with the Center for Innovation in the use of virtual healthcare to improve access toto Implementation (Ci2i), whose mission is to fos-care. When the pandemic caused shutdowns in 2020,terhigh-valuehealthcareforveterans.Because virtual care became even more important at the VA,maintaining access is a critical priority of VA, they with the percentage of outpatient visits conductedconducted the study to, identify veterans who might virtually rising from 14% prior to March 2020 tobenefit from outreach to increase adoption of video 58% by June.care, she said. A report from the VAs Office of Inspector GeneralThe team used data VA healthcare records to iden-pointedoutthatVApatientswithanytelehealthtify veterans who had and had not used video care encounterincreased181%inthefirstyearoftheinthefirstyearofthepandemicMarch2020pandemic, while telephone encounters increased byFebruary2021,Fergusonsaid.Then,amongthe 211%. As late as a year ago, 30% of outpatient careveterans who had at least one video visit, they cal-was still being conducted virtually. culated how many video visits they each had. We While the majority of this virtual care can be and isthenlookedatthedemographiccharacteristicsof conducted by telephone, many researchers are con- veterans who used video care and compared them to cerned that video-based carewhich VA leadershipthose who did not, she told U.S. Medicine. We also considers the preferred method due to its potentialexamined the type of care provided at each visit. For to provide a more comprehensive experienceisexample, was it a primary care visit, a mental health-not uniformly available to veterans.care visit or a specialty care visit? The rapid shift to video-based care from in-personTheresultscomparethelikelihoodofhavinga care may have exacerbated technology access dis- video visit and then the frequency of having a video parities known digital divide, Jacqueline Ferguson,visitamongveteranswithdifferentdemographic PhD, and her colleagues wrote in Health Servicescharacteristics.Research.IndividualswithtechnologicalaccessA unique finding was the difference in the fre-barriers may rely exclusively on in-person care. Asquency of video care use by race, Ferguson said, a result of the shift to video-based care they may beadding that the disparities observed likely reflect less able to access health care.1 theunequalconditionsinwhichpeopleliveOur study team is interested in studies that willthatis,socialdeterminantsofhealththatmight enhance the accessibility, capacity and quality of vir- stem from structural racism. We found American tual care that the VA offers veterans, said Ferguson,Indian/Alaska Native veterans were less likely to aresearchhealthsciencespecialistwiththeVAuse primary and specialty care health video visits Palo Alto Health Care System and virtual care corecompared to white veterans. Yet, American Indian/54'