High Users of Primary Care Secure Messaging in the Veterans Health Administration

Area of Science:

• Health Informatics
• Primary Care Medicine
• Health Services Research

Background:

• Secure messaging use is increasing in primary care settings.
• Understanding high-volume users of secure messaging is crucial for policy and resource allocation.
• Current data lacks detailed characterization of frequent secure messaging users in primary care.

Purpose of the Study:

• To characterize the demographic and clinical profiles of high-volume secure messaging users in the Veterans Health Administration (VHA).
• To assess the primary care and emergency department utilization patterns of these high users.
• To determine the proportion of total VHA primary care messages sent by high users.

Main Methods:

• A retrospective cross-sectional analysis of VHA primary care patients from October 2022 to September 2023.
• Multivariate logistic regression was used to identify characteristics associated with high user status (top 5% of message exchange).
• Analysis included descriptive statistics of user characteristics and healthcare utilization.

Main Results:

• Older veterans, those with higher frailty, physical comorbidities, and mental health conditions (schizophrenia, bipolar disorder, PTSD, anxiety, depression) were more likely to be high users.
• Black, Hispanic, Asian/Pacific Islander/Native Hawaiian, and male veterans were less likely to be high users.
• High users accounted for 30.5% of all secure messages, but few were also high users of in-person, video, or telephone primary care visits or emergency department services.

Conclusions:

• A small proportion of veterans generate a disproportionately large volume of secure messages.
• High secure messaging users often have complex health needs, including physical and mental health conditions.
• Racial disparities in secure messaging use exist, and high users typically do not concurrently overutilize other primary care or emergency services.