Telemedicine Use During the COVID-19 Pandemic by Resilient Rheumatology Providers: A National Veterans Affairs Follow-up Survey

Objective. To assess rheumatology provider experience and practices at Veterans Affairs (VA) facilities during the coronavirus disease 2019 (COVID-19) pandemic. Methods. We performed an anonymized follow-up national cross-sectional survey (November 5, 2020 to January 1, 2021) to assess provider resilience, experience, practices, views, and opinions about changes to medications and laboratory monitoring of veterans with rheumatic diseases. Results. Of the 143 eligible VA rheumatology providers, 114 (80%) responded. Compared to the original survey, fewer providers reported using telephone visits (78% vs 91%, P= 0.009), and more used clinical video telehealth (CVT; 16% vs 7%, P = 0.04) or in-person visits (76% vs 59%, P = 0.007). Most providers were somewhat or very comfortable with the quality of clinical encounters for established but not new patients for telephone, video-based VA Video Connect (VVC), and CVT. The mean 2-item Connor-Davidson Resilience Scale score was 6.85 (SD 1.06, range 0-8), significantly higher than the original April-May 2020 survey score of 6.35 (SD 1.26; P = 0.004). When adjusted for age, sex, and ethnicity, high provider resilience was associated with significantly higher odds of comfort with technology and the quality of the VVC visit for the following: (1) established patients (odds ratio [OR] 1.72, 95% CI, 0.67-4.40 and OR 4.13, 95% CI 1.49-11.44, respectively) and (2) new patients (OR 2.79, 95% CI 1.11-7.05, and OR 2.69, 95% CI 1.06-6.82, respectively). Conclusion. Reassuringly, VA rheumatology providers became increasingly comfortable with video visits during the first 10 months of the COVID-19 pandemic. High provider resilience, and its association with better quality CVTs, raise the possibility that video visits might be an acceptable substitute for in-person visits under appropriate circumstances.