The Veterans Administration’s use of telehealth can be via Clinical Video Telehealth (CVT), home monitoring, or by using mobile devices to match the clinical need. The VA’s Health Services Research & Development (HSR&D) program published a research highlight titled “Providing Care Closer to Home: The role of Virtual Points of Access”.
The article authored by Peter J Kaboli M.D and Carolyn Turvey PhD at the HSR&D Comprehensive Access and Delivery Research and Evaluation Center at the Iowa City VA Healthcare System, stresses the effective role that telehealth plays treating veterans in rural areas when treating chronic illnesses.
For example, the Telehealth Collaborative Care (TCC) model was initiated to provide team-based consultations to help rural veterans with HIV. The TCC model is able to integrate team-based HIV specialty care by Community Based Outpatient Clinics (CBOC) using CVT with primary care delivered by local Patient Aligned Care Teams (PACT).
So far, preliminary studies at the Iowa City VA indicate that TCC is well accepted by veterans and PACTS are able to maintain previously existing high quality HIV care. The VA is planning studies to evaluate spreading TCCs to serve more rural veterans with HIV.
Another example discusses how the VA is able to provide more access to rural veterans through collaboration with local non-VA health systems. A campus-based telemental health clinic at Western Illinois University was initiated by conducting negotiations between the Iowa City VA Mental Health Service Line and Student Health Services at WIU. Now veterans pursing a college degree can also receive expert care for service-related mental health issues directly from VA providers using CVT.
Lastly, a home-based cardiac rehabilitation program provides Phase 2 cardiac rehabilitation in the home of eligible veterans. Only 25 percent of VA hospitals provide cardiac rehabilitation onsite. This means that most veterans who receive cardiac rehabilitation are enrolled in community-based programs through non-VA care. To provide an alternative, the team developed a home program that uses telehealth.
The home program uses the telephone to engage patients in weekly sessions covering important topics such as diet and stress management. Telehealth usage includes using CVT to enroll patients from CBOCs. In this program veterans are offed the option of a home-based or center-based program. The majority of veterans like the home program and the completion rate is high.
Although all of the above examples were ultimately successful, each faced some significant implementation barriers that are common across the VA. These include workflow barriers to multidisciplinary care, administrative barriers to closer collaboration with non-VA providers, health information technology issues, hiring the right personnel, and under recognition of the value of actual care delivery closer to home. It was also found that implementing the technology was the easiest aspect of the interventions described.
Go to www.hsrd.research.va.gov/publications/forum/may14/default.cfm?ForumMenu=may14-5 for more information.