scholarly journals Spreading Telehealth for Older Adults in Rural Areas Through Network of Geriatric Interprofessional Teams

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 796-796
Author(s):  
Steven Barczi ◽  
Megan Gately ◽  
Lauren Welch ◽  
Kathryn Nearing ◽  
Stephen Thielke ◽  
...  
Keyword(s):  
Older Adults ◽  
Rural Areas ◽  
Urban Areas ◽  
Care Needs ◽  
Community Based ◽  
Team Care ◽  
Geriatric Consultation ◽  
Complex Care Needs ◽  
Nursing Professionals ◽  
Community Based Services

Abstract Older adults living in rural areas have limited access to geriatrics interprofessional team care. In the Veteran healthcare system, geriatric teams such as geriatricians, nursing professionals, social workers, pharmacists and psychologists, located in urban areas link up with rural clinics to provide geriatric consultation remotely through clinical video telehealth and other means in the project GRECC Connect. Since its inception in 2014, the service has now grown to 16 geriatric teams offering consultation to over 100 clinic sites serving older rural Veterans. GRECC Connect delivered over 2,000 consultations in 2019, meeting complex care needs by identifying and linking geriatric services and management to patients with geriatric syndromes. The network of established geriatric teams, local champions and a shared Electronic Health Record facilitated the spread, while ongoing effort to build and maintain relationships between consultants and local rural provider teams and other community based services are important for ongoing success.

scholarly journals A MULTI-SITE PROGRAM TO PROVIDE GERIATRICS TELECONSULTATION TO OLDER RURAL VETERANS (GRECC CONNECT)

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S608-S608
Author(s):  
William Hung ◽  
Steven Barczi ◽  
cathleen Colon-Emeric ◽  
Michelle Rossi ◽  
Stuti Dang ◽  
...  
Keyword(s):  
Older Adults ◽  
Rural Areas ◽  
Care Needs ◽  
Adult Care ◽  
Research Education ◽  
Team Care ◽  
Geriatric Consultation ◽  
Need Support ◽  
Rural Clinics ◽  
Geriatric Research

Abstract Older Veterans living in rural areas often do not have access to geriatrics team care; rural frontline providers and teams may need support to address the needs of older adults with complex chronic conditions. GRECC Connect aims to link up geriatric teams at Geriatric Research, Education and Clinical Centers (GRECCs) and rural clinics to provide geriatric consultation remotely through clinical video telehealth (CVT) and other means. GRECC Connect is established in twelve GRECCs across the country with links to rural clinics in their catchment area; consultations led to identification and meeting of care needs of older adults with complex conditions, improving medication use and reducing older adults’ need for travel to long distances for consultation. In this presentation, we review the experience of establishing connections with rural clinics, impact on older adult care and adaptations needed to address local needs and contexts.

scholarly journals ELDER ABUSE AMID THE OPIOID EPIDEMIC: APS CASES IN RURAL AMERICA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S763-S763
Author(s):  
Pamela B Teaster ◽  
Karen A Roberto ◽  
Jyoti Savla
Keyword(s):  
Older Adults ◽  
Elder Abuse ◽  
Standard Errors ◽  
Opioid Misuse ◽  
Rural America ◽  
Opioid Use ◽  
Care Needs ◽  
Community Based ◽  
Community Based Services ◽  
Physical Care

Abstract Older adults are hidden victims of the opioid crises, suffering abuse at the hands of those who seek resources to support their addiction. Using APS data from 2015-2017 provided by the Kentucky Department for Community-Based Services, we used a logistic regression model with robust standard errors to examine whether substantiated cases of elder abuse were associated with opioid misuse by perpetrators. Overall, 9% of the 462 substantiated cases over the three-year period involved perpetrators were substance users. The percentage of these cases rose from 5% in 2015 to 13% in 2016 before dropping to 7% of elder abuse cases in 2017. Opioid use was most prevalent among perpetrators of financial abuse of older adults with cognitive and/or physical care needs. The current study offers a first look at empirical linkages between opioid misuse and elder abuse and revealed consistencies across cases that call for further investigation.

scholarly journals Towards Better Health, Social, and Community-Based Services Integration for Patients with Chronic Conditions and Complex Care Needs: Stakeholders’ Recommendations

2020 ◽  
Vol 17 (22) ◽  
pp. 8437
Author(s):  
Catherine Hudon ◽  
Maud-Christine Chouinard ◽  
Marie-Dominique Beaulieu ◽  
Mathieu Bisson ◽  
Danielle Bouliane ◽  
...  
Keyword(s):  
Health Care Services ◽  
Interprofessional Collaboration ◽  
Inductive Method ◽  
Quebec City ◽  
Complex Care ◽  
Care Needs ◽  
Community Based ◽  
Services Integration ◽  
Complex Care Needs ◽  
Community Based Services

The objective was to report on issues related to patients with complex care needs and recommendations identified by 160 key participants at a summit in Quebec City about better integration of primary health care services for patients with chronic diseases and complex care needs. A descriptive qualitative approach was used. While focus groups were led by a facilitator, a rapporteur noted highlights and a research team member took independent notes. All notes were analyzed by using a thematic analysis according to an inductive method. Seven issues were identified, leading to the formulation of recommendations: (1) valuing the experience of the patient; (2) early detecting of a non-homogeneous patient population; (3) defining interprofessional collaboration based on patient needs; (4) conciliating services provided by clinical settings according to a registered clientele-based logic with the population-based logic; (5) working with the community sector; (6) aligning patient-oriented research values with existing challenges to primary care integration; and (7) promoting resource allocation consistent with targeted recommendations. The summit highlighted the importance of engaging all stakeholders in improvement of integrated care for patients with complex care needs. The resulting recommendations target shared priorities towards better health, social, and community-based services integration for these patients.

scholarly journals Digital ageing in Europe: a comparative analysis of Italian, Finnish and Swedish national policies on eHealth

2021 ◽  
pp. 1-22
Author(s):  
Heli Valokivi ◽  
Simone Carlo ◽  
Elin Kvist ◽  
Marjo Outila
Keyword(s):  
Older Adults ◽  
Rural Areas ◽  
Urban Areas ◽  
Care Needs ◽  
High Expectations ◽  
Policy Debates ◽  
High Age ◽  
Demographic Challenge ◽  
Digital Landscape

Abstract Ageing Europeans are today healthier than previous generations and often manage to live independently up to a high age. The proportion of people 80 years of age and older has increased significantly, and with high age the risk of multi-illness and dementia increases. Strong urbanisation processes have changed the demographic structure in rural areas, and young women and men have migrated towards the urban areas to study and work, while older persons have remained behind. This demographic challenge of increasing numbers of persons older than 80 years with care needs living in remote rural areas has become a major European social problem. In tackling this dilemma, many European countries have high expectations for eHealth, digitalisation and welfare technology. In this comparative study of policy debates in Italy, Finland and Sweden, we analyse how – between 2009 and 2019 – the issues of eHealth have been articulated in national and regional policies of the three countries with deep differences in terms of digitalisation and health systems, but with similar ageing populations. We identify in the documents three core topics – the role of technology, the rural issue and responsibility for care. These topics are treated in the documents with differences and similarities between the three countries. Beyond the differences and similarities, the documents reveal both a certain techno-enthusiasm about the role of eHealth in the life of the older adults as well as a limited understanding of the complexity (relationally as well as spatially) of the digital landscape of caring for older adults.

Location Matters: Disparities in the Likelihood of Receiving Services in Late Life

2020 ◽  
pp. 009141502094820
Author(s):  
Raven H. Weaver ◽  
Karen A. Roberto
Keyword(s):  
Older Adults ◽  
Service Delivery ◽  
Home Care ◽  
Rural Areas ◽  
Late Life ◽  
Community Based ◽  
Fresh Food ◽  
Delivery Strategies ◽  
To Receive ◽  
Community Based Services

Moving beyond typical dichotomous rural–urban categorizations, this study examines older adults’ likelihood of receiving home- and community-based services. Data from 1608 individuals aged 60+ who requested assistance from Area Agencies on Aging in Virginia in 2014–2015 were analyzed; 88% of individuals received at least one service. Receiving services was associated with geographic-based factors. Individuals living in completely rural areas were significantly less likely to receive any service compared to individuals in mostly rural (OR = 2.46, p = .003) and mostly urban (OR = 1.97, p = .024) areas. There were subtle but significant geographic-based differences in the likelihood of receiving specific services including food/meal, fresh food, information and referral, in-home care, utilities support, and transportation. Findings provide nuanced insights about geographic-based disparities in the receipt of services and suggest the need for new and modified service delivery strategies that maximize older adults’ ability to live.

scholarly journals Bypassing primary care facilities: health-seeking behavior of middle age and older adults in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Changle Li ◽  
Zhuo Chen ◽  
M. Mahmud Khan
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health System ◽  
Rural Areas ◽  
Urban Areas ◽  
Chinese Patients ◽  
Care Needs ◽  
Healthcare Facilities ◽  
Primary Health ◽  
Care Facilities

Abstract Background With economic development, aging of the population, improved insurance coverage, and the absence of a formal referral system, bypassing primary healthcare facilities appear to have become more common. Chinese patients tend to visit the secondary or tertiary healthcare facilities directly leading to overcrowding at the higher-level facilities. This study attempts to analyze the factors associated with bypassing primary care facilities among patients of age 45 years or older in China. Methods Random effects logistic models were used to examine bypassing of primary health facilities among rural-urban patients. Data from 2011 to 2015 waves of the China Health and Retirement Longitudinal Study were used. Results Two in five older patients in China bypass primary health centers (PHC) to access care from higher-tier facilities. Urban patients were nearly twice as likely as rural patients to bypass PHC. Regardless of rural-urban residence, our analysis found that a longer travel time to primary facilities compared to higher-tier facilities increases the likelihood of bypassing. Patients with higher educational attainment were more likely to bypass PHCs. In rural areas, patients who reported their health as poor or those who experienced a recent hospitalization had a higher probability of bypassing PHC. In urban areas, older adults (age 65 years or older) were more likely to bypass PHC than the younger group. Patients with chronic conditions like diabetes also had a higher probability of bypassing. Conclusions The findings indicate the importance of strengthening the PHCs in China to improve the efficiency and effectiveness of the health system. Significantly lower out-of-pocket costs at the PHC compared to costs at the higher tiers had little or no impact on increasing the likelihood of utilizing the PHCs. Improving service quality, providing comprehensive person-centered care, focusing on family health care needs, and providing critical preventive services will help increase utilization of PHCs as well as the effectiveness and efficiency of the health system.

scholarly journals GRECC Connect Increases Access to Geriatric Specialty Care for Rural, Older Veterans With Complex Care Needs

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 795-796
Author(s):  
Kathryn Nearing ◽  
Stuti Dang ◽  
Eileen Dryden ◽  
Laura Kernan ◽  
Lauren Moo ◽  
...  
Keyword(s):  
Rural Areas ◽  
Video On Demand ◽  
Specialty Care ◽  
Multiple Chronic Conditions ◽  
Care Needs ◽  
Community Based ◽  
Therapeutic Alliances ◽  
Caregiver Support ◽  
Complex Needs ◽  
Complex Care Needs

Abstract A higher percentage of Veterans in rural areas are older, have multiple chronic conditions and select the VA for healthcare. To address the needs of rural older Veterans with complex needs, GRECC Connect hubs use case finding approaches combined with regular outreach and education to VA community-based outpatient clinic (CBOC) providers serving rural Veterans and caregivers. Alignment of GRECC Connect services with needs of providers and patients promotes establishment of therapeutic alliances in caring for medically complex older Veterans. After identifying high risk, high need patients, hubs use the following strategies to increase access to geriatric specialty care through telehealth modalities: 1) Co-management of patients through e-consultation and telehuddles (GRECC Connect interprofessional geriatric specialty care teams extend support to CBOC providers); 2) Clinical video telehealth to CBOCs and Video on Demand to Veteran homes (to reduce travel burden); and, 3) Tele-group visits (especially for behavioral health and caregiver support).

scholarly journals Telehealth as an Element of Home and Community-Based Services in a Pandemic: An Intrinsic Case Study in Two Rural Areas

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 742-742
Author(s):  
Nancy Karlin ◽  
Joyce Weil
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Rural Communities ◽  
Rural Areas ◽  
Older Persons ◽  
Care Delivery ◽  
Health Care Systems ◽  
Community Based ◽  
Care Systems ◽  
Community Based Services

Abstract COVID-19 has changed the face of health care delivery. Using technology as a way to ensure Home and Community-Based Services (HCBS) as an option for older adults in rural areas is of increasing interest as a result of the pandemic. Literature suggests older adults do not adopt telehealth and/or medicine practices due to barriers (e.g., Internet and computer availability) and do not use telemedicine as a form of communication with medical staff. However, the combination of needing health care during the pandemic and having federal coverage via Medicare for telehealth virtual visit. Still studies suggest older adults may lack the necessary information about how to adopt telehealth and telemedicine and that they do not see their benefits. Additionally, the cost of technology, limited Internet access and rural connectivity issues persist. This study evaluates the potential for telehealth/medicine use in rural communities through two case studies of rural older persons in the Eastern Plains of Colorado and rural Western Nebraska. Results indicate, for older persons responding to the telehealth/medicine questions, there is support for its potential use with some using teleconferencing, health portals, along with the expectation that telehealth/medicine would be part of new health care systems. Resistance was met by some older adults in the Colorado sample who preferred face-to-face contact alongside other concerns about potential usage barriers such as the lack of Internet services or consistent connectivity. These participants indicated a lack of awareness in finding out how to access this form of medical support.

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