Did Access to Specialty Care Change for US Veterans During the COVID-19 Pandemic?

Increased waits for both Veterans Heath Administration (VHA) and community-based specialists and decreased referral volume for US veterans were correlated with the onset of the COVID-19 pandemic, according to findings published in JAMA Network Open.

The VHA Corporate Data Warehouse was searched for all new patient referrals to special care between January 1, 2019, and December 31, 2021.

Total appointment volume and mean wait times monthly were calculated and stratified by referral to community-based specialists and VHA, noted researchers.

During the study period, the VHA completed 14,516,937 internal referrals and purchased an additional 9,904,312 referral to community-based specialists.

Participants in the study had a mean age of 63.8 (15.2) years, 87.2% were male, 72.2% had some level of service-connected disability, and 54% were married.

Researchers reported that VHA specialists completed a mean 452,148 (30,726) referrals each month between January 1, 2019, and January 31, 2020.

Findings showed that in March 2020, volume began dropping and by April 2020, referrals declined by 70.7% to 132,481, which did not fully recover until March 2021.

An increase in referrals to community-based specialists was observed prior to COVID-19 with a continued increase until April 2020 with (321,329 referrals).

In June 2020, community care referrals declined by 32.9% to 215,768, but by March 2021 they exceeded the prepandemic baseline.

“Mean waits for community-based specialists exceeded VHA waits before the pandemic (38.6 [20.8] vs 32.8 [18.0] days; P < .001) and throughout the study period,” wrote study authors. Waits for VHA specialists began rising in June 2020, peaked in July 2020 (+8.2 days vs January “2020; P < .001) and returned to prepandemic levels by spring 2021.”

In June 2020 mean waits for community specialists peaked (+4.8 days vs January 2020; P < .001), but by August 2020 returned to their prepandemic baseline.

“Study limitations include the inability to identify clinical appropriateness of observed waits or mechanisms underlying the observed changes in referral volume or waits,” concluded researchers. “Future work should examine the health consequences of these delays in care due to COVID-19.”

Reference:
Griffith KN, Asfaw DA, Childers RG, et al. Changes in US veterans’ access to specialty care during the COVID-19 pandemic. JAMA Netw Open. 2022;5(9):e2232515. doi:10.1001/jamanetworkopen.2022.32515