Telehealth Complementary and Integrative Health Therapies During COVID-19 at the U.S. Department of Veterans Affairs

Author: Claudia Der-Martirosian1,2, Marlena Shin3, Michelle L Upham4, Jamie H Douglas4, Steven B Zeliadt4,5, Stephanie L Taylor1,6
1 Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
2 Veterans Emergency Management Evaluation Center, Office of Patient Care Services, North Hills, California, USA.
3 Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.
4 VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, USA.
5 Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA.
6 Department of Medicine and Department of Health Policy and Management, University of California Los Angeles, Los Angeles, California, USA.
Conference/Journal: Telemed J E Health
Date published: 2022 Jul 22
Other: Special Notes: doi: 10.1089/tmj.2022.0209. , Word Count: 264

Background: Complementary and integrative health (CIH) therapies, such as in-person acupuncture, chiropractic care, and meditation, are evidence-based nonpharmaceutical treatment options for pain. During COVID-19, the Veterans Health Administration (VA) delivered several CIH therapies virtually. This study explores veterans' utilization, advantages/disadvantages, and delivery issues of yoga, Tai Chi, meditation/mindfulness (self-care), and massage, chiropractic, and acupuncture (practitioner-delivered care), using telephone/video at 18 VA sites during COVID-19. Methods: Use of virtual care was examined quantitatively with VA administrative data for six CIH therapies before and after COVID-19 onset (2019-2021). Advantages/disadvantages and health care delivery issues of these CIH therapies through virtual care were examined qualitatively using interview data (2020-2021). Results: Overall, televisits represented a substantial portion of all CIH self-care therapies delivered by VA in 2020 (53.7%) and 2021 (82.1%), as sites developed virtual group classes using VA secure online video platforms in response to COVID-19. In contrast, a small proportion of all encounters with acupuncturists, chiropractors, and massage therapists was telephone/video encounters in 2020 (17.3%) and in 2021 (5.4%). These were predominantly one-on-one care in the form of education, follow-ups, home exercises, assessments/evaluations, or acupressure. Delivery issues included technical difficulties, lack of access to needed technology, difficulty tracking virtual visits, and capacity restrictions. Advantages included increased access to self-care, increased patient receptivity to engaging in self-care, and flexibility in staffing online group classes. Disadvantages included patient preference, patient safety, and strain on staffing. Conclusion: Despite delivery issues or disadvantages of tele-CIH self-care, veterans' use of teleself-care CIH therapies grew substantially during the COVID-19 pandemic.

Keywords: COVID-19; complementary and integrative health therapies; practitioner-delivered care; self-care; telehealth; veterans.

PMID: 35867052 DOI: 10.1089/tmj.2022.0209