Black veterans less able to manage chronic pain via telehealth services

Black veterans with chronic pain were found to have had negative experiences with virtual care during the COVID-19 pandemic, according to a new study published in the Journal of General Internal Medicine.  

The majority of patients in the U.S. Department of Veterans Affairs (VA)-funded study reported negative perceptions of telehealth and changes to their care, including disruptions to care and access and delivery barriers. Patients recounted being less able to manage their chronic pain and shared challenges in seeing their primary care provider in person or obtaining nonpharmacological services like physical therapy.

“Looking at what we found adds a note of caution that even as virtual healthcare is being used more and more, we need to make sure that no one is left behind as it becomes more commonplace,” Marianne Matthias, Ph.D., the first author of the paper, a core investigator at the VA and senior research professor of medicine at Indiana University (IU) School of Medicine, said in a statement. “We also need to make sure that virtual healthcare is used in an equitable way and that people are having relatively even experiences with telehealth services.”

Matthias and Johanne Eliacin, Ph.D., both Regenstrief Institute and VA researchers and IU School of Medicine faculty, designed the qualitative study in order to transcend the limits of quantitative assessments of the technology’s efficacy.

Between the beginning of March and the end of April 2020, the number of weekly videos visits at the VA increased by a factor of seven for mental health care appointments, a factor of 13 for primary care and by more than 17 for specialty care and rehabilitation.

Most respondents stated that telehealth did not meet their needs and reported feeling inadequately assessed for their pain. Researchers noted that patients felt that beyond renewing prescriptions, telehealth visits were not that useful.

Some patients assented that they were willing to accept the trade-off of virtual care for avoiding possible exposure to COVID-19 and that they appreciated the convenience of virtual care.

“In this study, we wanted to know our patients on a personal level and learn about their life experiences—to hear how they manage their care in their own words and to capture a level of detail and experiences that are not accessible using quantitative research methods,” Eliacin said.

“There were several quantitative studies during the pandemic looking at access to care, but not very many qualitative studies, so the data collected is valuable when trying to understand the usefulness of telehealth among Black veterans.”

The researchers emphasized that while the study results are not generalizable beyond the group of Black veterans experiencing chronic pain, the responses provide insight into how inequalities in healthcare translate to a digital space.

Black patients continue to experience greater pain severity, worse pain outcomes and inadequate pain treatment while also reporting poorer quality communication with providers and receiving less health information. The VA and the veteran experience of healthcare are not exempt from these findings.  

Experts have expressed concern that while a move to digital care provides an opportunity for increasing racial equity in treatment, new technology does not equate with equitable care. Studies have shown that non-white patients are overall less likely to use telehealth services.

Study participants were recruited from Matthias’ clinical trial, Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE), focusing on supporting Black veterans experiencing chronic pain by providing tools to facilitate autonomy and control over their health.