The Office of Rural Health (ORH) www.ruralhealth.va.gov within the Veterans Administration, reports that 5.2 million veterans live in rural communities across the U.S and more than 32.9 million rural veterans rely on the VA www.va.gov for their healthcare. The ORH is working to accurately gauge where specific gaps in care for this veteran population exist.
It was just announced by ORH that $219.2 million was awarded to increase veterans’ access to healthcare in rural areas. This funding provides new initiatives at 400 VA medical centers and community-based outpatient clinic sites in more than 45 states across the U.S with more sites expected throughout FY 2017.
The five categories to receive funding include primary care ($61.7 million), mental health ($22.5 million), specialty care services ($57.4 million), workforce training and education ($10.7 million), and ancillary support services mainly for transportation ($66.9 million).
One area that has been very active is the VA’s Telehealth program which has proven to be very valuable in treating veterans with HIV in rural communities. Michael Ohl MD and colleagues at the VA’s HSR&D’s Center for Comprehensive Access and Delivery Research and Evaluation www.hsrd.research.va.gov/centers/cadre.cfm have been actively working to improve access to high quality care for veterans infected with HIV.
As it turns out, the VA is the largest provider of HIV care in the U.S with about 26,000 veterans in care. However, about 16 percent of veterans with HIV live in rural areas and many live more than an hour drive from the nearest infectious disease specialty clinic. These clinics often lack the capacity to provide routine primary care for an aging population of veterans with HIV.
The fact is that veterans who reliably take HIV medicines will have an essentially normal lifespan but are dealing with problems associated with aging such as high blood pressure, diabetes, and heart disease. This means that there is need for new models to deliver HIV care to provide high quality primary care for an aging population of veterans with HIV.
To assist with these issues, Dr. Ohl and his team have developed a telehealth collaborative care model to provide accessible and comprehensive care for aging veterans with HIV. This care model combines delivering not only infectious disease specialty care via telemedicine, but also delivering local primary care in VA clinics serving rural areas.
In this model, nurse care coordinators use VA’s integrated EHR and case registries to coordinate local primary care with specialty care. A pilot study in Iowa City found that 96 percent of veterans with HIV wanted to use telehealth for their medical care instead of traveling to the distant specialty clinic.
Today, more than 90 percent of the veterans treated are able to maintain an undetectable level of HIV in their blood while on medicines. Dr. Ohl is currently working with the ORH to spread this telehealth collaborative care model to the Dallas, San Antonio, and Houston VA facilities.