Offering in-home video visits: a descriptive national survey of interprofessional clinicians across Veterans Health Administration

Abstract

Utilization of telehealth has greatly expanded in recent years to ensure access to care during uncertain times such as the COVID pandemic. This included offering telehealth to patients not previously considered ideal candidates for telehealth. In-home synchronous video telehealth has unique knowledge and technical requirements and barriers when compared to other modalities like telephone or asynchronous websites and applications. The complexity of in-home video may limit its reach to certain patients, including older adults and those with complex medical needs, thereby exacerbating care disparities. While clinicians may be critical decision-makers in determining use of in-home video, little is known about how clinicians decide to whom video should be offered. To ensure equitable distribution of in-home video to patients who need it most, this study investigates clinician decision-making around the initial offer of in-home video and what factors influence their decision. A web-based national survey of Department of Veterans Health Affairs (VHA) interprofessional clinicians about decision-making to offer in-home video was conducted between March and April 2025. The analytic sample includes clinicians who used in-home video during the previous 12 months. Items were iteratively developed with input from interprofessional clinician subject matter experts, and gathered, 1) respondent characteristics, 2) clinical experience and video utilization details, 3) patient, clinical, and administrative factors, benefits, and barriers, and 4) video facilitators. Of 11,416 respondents (5.5% response rate), most were female (68.31%), and the top three clinical disciplines included Social Workers (21.84%), Physicians (18.5%), and Nursing Professionals (15.22%). The top three clinical services delivered using in-home video were routine assessments or examinations (49.18%), assessments or examinations of new or acute issues (41.62%), and ongoing chronic disease management (40.92%). When clinicians were asked to rate the quality of care delivered via in-home video compared to in the clinic, the majority reported that they feel the quality is about the same or better when using video (84.20%). The top three patient factors that clinicians consider when deciding to offer in-home video included patient willingness and/or preference for video (77.58%), travel barriers including inclement weather, lack of transportation, traffic (76.35%), and rurality or distance from a VHA facility (74.43%). Patient factors selected the least included motor and sensory function (2,504, 21.93%), medical acuity (2,776, 24.32%), and age (3,107, 27.22%). The top three clinical and administrative factors identified as making the clinician more likely to offer in-home video included the convenience of using video to the clinician's workflow (55.23%), high patient acuity or the need to be seen quickly (55.02%), and the need for frequent follow-ups (49.21%). When clinicians were asked about the benefits of using in-home video with patients, they reported that video eliminates the need for patients to travel to and from appointments (72.80%), increased convenience for patients (70.94%), and reduced stress on patients or caregivers (60.03%). The top three most effective facilitators were automatically generated reminder emails (84.87%), reminder emails sent by the clinician or clinical staff (77.21%), and VHA-provided tablets (75.51%). Our findings highlight that patient-centered factors and benefits were most frequently reported by VHA clinicians as considerations when deciding to offer in-home video. Although clinician and administrative barriers were infrequently endorsed, patient-level challenges such as limited broadband access and difficulty using technology remained significant obstacles. To gain more detailed understanding, future research should explore the nuance behind clinician perspectives and potential biases in the offer of in-home video to help address the digital divide and disparities in access between subgroups of patients.