Telehealth Utilization for Primary Care Delivery During Hurricanes Michael (2018) and Ian (2022) in the Veterans...

Background: Maintaining primary care during disasters is crucial for mitigating health impacts. Telehealth can facilitate continuity but is often underutilized. The Veteran's Health Administration (VA) rapidly increased telehealth capacity in 2020, but the impact on disaster telehealth utilization remains unknown. We analyzed the impact of two hurricanes (Hurricane Michael in 2018 and Hurricane Ian in 2022) on telehealth utilization by VA primary care facilities. Design: Interrupted time series analysis of primary care visits to VA facilities in hurricane-affected states for 7 days before and 14 days following each event. Primary care visits were identified from the VA Corporate Data Warehouse. The primary outcome was the proportion of visits conducted virtually after each hurricane. Models included patient demographics, facility rurality, storm severity, and baseline facility telehealth capacity. Results: Seventy-eight VA facilities were evaluated for Hurricane Michael and 126 for Hurricane Ian. After covariate adjustment, Michael was associated with an immediate increase in the proportion of telehealth visits by 8.5 percentage points (95% confidence interval [CI]: 4.3%-12.7%, p < 0.001) and Ian by 12.3 percentage points (95% CI: 8.4%-16.1%, p < 0.001). Analyses by facility rurality demonstrated significant increases in telehealth for urban and rural facilities following Michael in 2018 (urban: 7.1%, 95% CI: 2.7%-11.5%, p < 0.001; rural: 15.1%, 95% CI: 4.5%-25.7%, p < 0.001) but only for urban facilities following Ian in 2022 (13.8%, 95% CI: 9.7%-18.0%, p < 0.001). Increases in telehealth utilization were larger for facilities in severely damaged areas. Conclusions: Telehealth was critical to VA primary care delivery during both hurricanes, with higher utilization seen in 2022 likely from the intervening scale-up of telehealth capacity. Rural facilities may be lagging in disaster telehealth utilization, exacerbating disparities in care delivery.