Assessing Patient Characteristics Associated with Virtual Visits of Chiropractic Patients in the Veterans Health Administration During the COVID-19 Pandemic: A Multivariable Cross-Sectional Analysis (Preprint)

BACKGROUND Non-pharmacological care is recommended as a first line approach to managing musculoskeletal (MSK) pain conditions, yet the COVID-19 pandemic has created obstacles to patients receiving this care and has increased the potential for patients to receive opioids and other pharmacologic forms of pain management. The use of virtual care for non-pharmacological therapies has become an important are of interest. Analyses of patient characteristics associated with such virtual visits has yet to be performed. OBJECTIVE To understand the patient characteristics associated with face-to-face (F2F) and virtual visits of patients receiving one type of nonpharmacological management, chiropractic care, in the U.S. Veterans Health Administration (VHA) during COVID-19 pandemic. METHODS Demographic data from patients receiving chiropractic care in the VHA were obtained from the VHA Corporate Data Warehouse from March 1, 2020 to February 28, 2021. Patients were grouped into mutually exclusive categories of those having only virtual visits, those having F2F visits, and those having F2F and virtual visits in this study period. Demographics included age, gender, race, ethnicity, marital status, and diagnostic codes (International Classification of Diseases 9th and 10th Editions [ICD-9 and ICD-10]) associated with non-musculoskeletal comorbidities. The diagnostic codes were used to calculate each patient’s Charlson Comorbidity Index. Multinomial logistic regression analysis was performed on demographic and comorbidity data. RESULTS The total number of unique patients receiving chiropractic care during the study period was 62,658. Non-White and Hispanic or Latino patients were more likely to attend both Virtual only (Black [odds ratio 1.20, 95% confidence interval (1.10, 1.31)], other races [1.36 (1.16, 1.59)], and Hispanic or Latino patients [1.35 (1.20, 1.52)] and combination F2F and virtual care (Black [1.32 (1.25, 1.40)], other races [1.37 (1.23, 1.52)], and Hispanic or Latino [1.63 (1.51, 1.76)]). We also found associations with patients less than 40 years of age [1.13 (1.02, 1.26)], 66-75 [1.17 (1.01, 1.35)], >75 [1.26 (1.06, 1.51)]. CONCLUSIONS Patients primarily using virtual chiropractic care or a combination of virtual and F2F care are more ethnically and racially diverse than those using only F2F care. These insights can serve to inform future work assessing virtual non-pharmacological care for MSK conditions.