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

INDIANAPOLIS -- Regenstrief Institute and U.S. Department of Veterans Affairs researchers Marianne Matthias, PhD, and Johanne Eliacin, PhD, 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 Journal of General Internal Medicine. This work was supported by a Department of Veterans Affairs Health Services Research and Development Merit Review Award to Dr. Matthias (IIR 17-032) and by a COVID-specific supplement to this award. Dr. Eliacin’s effort was supported by a Department of Veterans Affairs Health Services and Development Career Development Award (CDA 16-153).

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.

Authors and affiliations

1. VA HSR&D Center for Health Information and Communication, Indianapolis, IN, USA

Marianne S. Matthias PhD and Johanne Eliacin PhD

2. Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

Marianne S. Matthias PhD, Johanne Eliacin, PhD

3. Regenstrief Institute, Indianapolis, IN, USA

Marianne S. Matthias PhD and Johanne Eliacin PhD

4. Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN, USA

Diana J. Burgess PhD

5. Department of Medicine, University of Minnesota, Minneapolis, MN, USA

Diana J. Burgess PhD

Corresponding author: Marianne S. Matthias PhD

Marianne S. Matthias, PhD

In addition to her role as a research scientist at Regenstrief Institute, Marianne S. Matthias, PhD, is a core investigator for the U.S. Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis. She is also a senior research professor of medicine at Indiana University School of Medicine.

Johanne Eliacin, PhD

In addition to being a research scientist at Regenstrief Institute, Johanne Eliacin, PhD, is a core investigator at the U.S. Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication at Richard L. Roudebush VA Medical Center, Indianapolis. She is also an assistant research professor of medicine at IU School of Medicine and a research scientist at the Indiana Alzheimer’s Disease Research Center.

About Veteran Health Indiana and CHIC       

The Richard L. Roudebush VA Medical Center is the flagship medical center for Veteran Health Indiana, the VA’s healthcare system in central and southern Indiana. The medical center is located in downtown Indianapolis and is collocated with three large community hospitals and the campus of the Indiana University Schools of Medicine and Nursing. The health system has been serving Hoosier Veterans since 1932. As Indiana’s Level 1a, tertiary care Veteran facility, the medical center serves as home base for a system of inpatient and outpatient care locations serving more than 62,000 Veterans.

The VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) group is a diverse cadre of researchers based at Roudebush VA Medical Center who work together to transform the healthcare system, both within and outside the VA so every patient receives consistent, high-quality care.

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

About IU School of Medicine
IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.