Special to Federal Telemedicine News

       Solving the Rural Veteran Care Crisis with Telemedicine

                                            Author

                                   Joel E. Barthelemy

                              Founder & CEO GlobalMed

 Only 15 percent of Americans live in rural areas, but a quarter of U.S. veterans do. This reality can have negative implications for their health for several reasons. Rural Americans tend to have higher rates of chronic disease like diabetes, heart failure and COPD, as well as higher mortality rates; they also have higher rates of tobacco use and poverty. Rural areas also tend to have fewer local healthcare resources. For every 100,000 urban residents, there are 263 specialists. Rural residents only have 30.

While those numbers are dire on their own, they look worse when you consider that 25 percent of veterans overall have service-connected disabilities – and that number rises to 41 percent for veterans who’ve served after the terrorist attacks of Sept. 11, 2001. These veterans typically depend on Veterans Health Administration (VA) hospitals for care, but the nearest fully-staffed VA facilities are often far away from small towns and remote areas. Community-Based Outpatient Clinics (CBOC) can help but they tend to lack specialty services.

Luckily telemedicine can address gaps in veterans’ health. Common services like preventive screenings, early cancer detection, prenatal care, tobacco cessation and opioid use disorder treatment can all be virtually delivered to farming, ranching and tribal communities. As the FCC Commissioner Brendan Carr said, “With advances in telemedicine, healthcare is no longer limited to the confines of traditional brick and mortar health care facilities… With an Internet connection, patients can now access high-quality care right on their smartphones, tablets, or other devices regardless of where they are located.”

This is especially true for audiology services and behavioral care – two clinical disciplines in high demand in the veteran world. The top three service disabilities for veterans are hearing loss, tinnitus, and post-traumatic stress disorder (PTSD.) Many veterans have been exposed to intense noise levels like gunfire, aircraft and heavy machinery; many have also experienced traumatic or shocking events, both in and out of combat. Yet a shortage of audiologists typically means a long wait time for audiologic testing, while a scarcity of behavioral specialists in rural areas can make it tough for veterans to find in-person care.

Restoring Hearing – and Quality of Life

Consider my father, a U.S. Army veteran of both World War II and the Korean War. Because he’d lost much of his hearing in the service, his later years involved monthly visits to audiology specialists. But despite living less than a mile from a VA hospital, he had to travel 85 miles by bus each way to a different VA hospital because it had staff audiologists. Between waiting for the bus and the journey itself, each appointment involved a 13-hour day.

Today he would be able to access audiology services right from his local hospital – not necessarily because of onsite audiologists but because VA now uses teleaudiology to bring convenient care options to rural veterans. Working in tandem with trained technicians, remote audiology professionals can offer accurate diagnostic testing, hearing-aid fitting and programming, and auditory rehabilitation education that optimizes the veteran’s residual hearing. Help can be as close as the veteran’s local CBOC.

The benefits are life changing. Veterans can skip the audiology wait list and be tested in just minutes. Because they no longer need to drive four hours for a 30-minute appointment, the teleaudiology services have decreased the rate of no-shows. Most importantly, these veterans are receiving the treatment for tinnitus and hearing loss needed to build social connections and succeed professionally – helping them live vibrant lives.

Empowering Veterans to Build Bright Futures

Of the 1.7 million U.S. veterans who are service-connected for mental health conditions, one million are diagnosed with PTSD. Yet the shortage of mental health professionals can make it tough for rural veterans to receive consistent behavioral care.

One example is Jared Lunstad, who was discharged from the Air Force in February 2015. As part of his transition from active duty to civilian life, he moved to Minot, North Dakota to pursue his college education. But Minot is a small town with limited healthcare resources and Lunstad had a service-related diagnosis of PTSD to address.

Lunstad arranged treatment through his local CBOC, but the providers he needed were in the Veterans Affairs Medical Center in Fargo, North Dakota – four hours from his home. In addition to studying for his Bachelor’s degree, he was working full time. Traveling back and forth for appointments simply wasn’t a realistic option. That was when the Minot CBOC staff introduced him to telemedicine. “I thought it was a pretty great option,” he recalled. “It saves time and driving and the headache of all those trips.”

Lunstad began consistently connecting to a psychiatrist and counselor located in the VA Medical Center in Fargo. In addition to talk therapy and medication management, he’s received annual checkups, skin cancer screenings and other preventive care through telemedicine. He says it’s helped him stay healthy while balancing the demands of work and college.

“Being in Minot for school, I’m very grateful for telemedicine because it allows me to do this and still get care,” he said. “If I didn’t have this resource available, I’d probably just go without medical help rather than move to Fargo where the resources are. It makes all the difference.”

Transforming Rural Opportunities

The day is coming when people of all backgrounds will no longer feel they have to choose between small town life and big city resources. 21st century tools like telemedicine are bringing advanced care to the patient so they can live where they like while getting the treatment they need – a quality of life our veterans deserve.

About the author

Joel E. Barthelemy is founder and CEO of GlobalMed, a virtual health company that is honored to be the telehealth provider to the White House, Dept. of Veterans Affairs, and the Defense Health Agency and many commercial healthcare systems in the U.S. and around the world. Joel can be reached at jbmkt@globalmed.com.

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