Study examines healthcare access and telehealth delivery for Black veterans with chronic pain during COVID-19

Regenstrief Institute and U.S. Department of Veterans Affairs researchers Marianne Matthias, Ph.D., and Johanne Eliacin, Ph.D., have taken a more personalized approach to understand how Black veterans with chronic pain experienced changes in healthcare delivery, including rapid increases in virtual delivery of healthcare, during the height of the COVID-19 pandemic.

Through qualitative interviews, Drs. Matthias and Eliacin—both also faculty at Indiana University School of Medicine—sought to understand how Black patients with chronic pain experienced the effects of the COVID-19 pandemic on healthcare access and delivery.

Most participants in this VA-funded study described negative perceptions about changes in their care, including disruptions in care, access to care and delivery of telehealth, in the period shortly after the pandemic's onset. Some described being less able to self-manage their chronic pain; others described having difficulty seeing their primary care providers in person, obtaining nonpharmacological services such as physical therapy and chiropractic care and scheduling surgery.

Importantly, a few patients identified positive experiences with telehealth early in the pandemic. Some appreciated the convenience of accessing healthcare from home and were willing to accept tradeoffs associated with telehealth if it meant preventing potential exposure to COVID-19.

Because this was a qualitative study, findings are not generalizable beyond this group of Black veterans who were interviewed, but they provide rich, detailed accounts of experiences with healthcare delivery and access to telehealth in the months immediately following the pandemic's onset. The authors note the need for follow-up studies that examine longer-term effects of the pandemic and the shift to telehealth for Black patients with chronic pain.

"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 from their own words, and to capture a level of detail and experiences that are not accessible using quantitative research methods," said senior author Dr. Eliacin, who studies health disparities.

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." Dr. Eliacin is a core investigator at the VA and also an assistant research professor of medicine at IU University School of Medicine.

"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," said Dr. Matthias, the first author of the paper, a core investigator at the VA and senior research professor of medicine at IU School of Medicine. "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."

"Healthcare Access and Delivery During the COVID-19 Pandemic for Black Veterans with Chronic Pain: a Qualitative Study," is published in the Journal of General Internal Medicine.

Participants in the current study were recruited from Dr. Matthias' clinical trial, COOPERATE: "Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE): Rationale, study design, methods, and sample characteristics." COOPERATE (Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity), is one of the first studies focused on equipping Black veterans who have chronic pain with tools to facilitate autonomy and control over their own healthcare. The study was recently completed and results are forthcoming.