Implementation of Telehealth Services at the VA during COVID-19 (Preprint)

2021 ◽  
Author(s):  
Claudia Der-Martirosian ◽  
Tamar Wyte-Lake ◽  
Michelle Balut ◽  
Karen Chu ◽  
Leonie Heyworth ◽  
...  
Keyword(s):  
Primary Care ◽  
Los Angeles ◽  
Medical Center ◽  
Low Cost ◽  
Patient Choice ◽  
Department Of Veterans Affairs ◽  
Telephone Interviews ◽  
Qualitative Approaches ◽  
Home Based ◽  
State And Local

BACKGROUND At the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting non-urgent in-person appointments. Even though, the VA was an early adopter of telehealth in the late 1990’s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020. OBJECTIVE We compare telehealth services use at one VA Medical Center, Greater Los Angeles across three clinics, primary care (PC), cardiology, and home-based primary care (HBPC), 12-months before and 12-months after onset of COVID-19 (March 2020). METHODS We used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of the percentage of monthly telehealth visits, as well as telephone vs. VA Video Connect (VVC) visits were examined for each clinic. Semi-structured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC, during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes. RESULTS Prior to COVID-19, telehealth use varied (7%-27%), but at the onset of COVID-19, telehealth use increased substantially and reached its peak: 80% PC (April 2020), 70% cardiology, 79% HBPC (both in May 2020). Telephone was the main modality of patient choice. Several important barriers and facilitators were noted: multiple steps to use video, flexibility in using different video-capable platforms, provision of free/low-cost infrastructure (devices, internet access), scheduling and staffing considerations, technical support for patients, identifying staff telehealth champions, and developing workflows to help incorporate telehealth into treatment plans. CONCLUSIONS Technological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions that improve access to care beyond the pandemic.

scholarly journals Preparedness and Response Activities of the VA Home-Based Primary Care Program Around the Fall 2017 Hurricane Season

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 591-591
Author(s):  
Tamar Wyte-Lake ◽  
Claudia Der-Martirosian ◽  
Aram Dobalian
Keyword(s):  
Primary Care ◽  
Large Scale ◽  
Care Program ◽  
Department Of Veterans Affairs ◽  
Home Based Primary Care ◽  
Home Based ◽  
Early Implementation ◽  
Hurricane Season ◽  
Patient Health ◽  
At Risk Populations

Abstract Individuals aged seventy-five or older, who often present with multiple comorbidities and decreased functional status, typically prefer to age in their homes. Additionally, as in-home medical equipment evolves, more medically vulnerable individuals can receive care at home. Concomitantly, large-scale natural disasters disproportionally affect both the medically complex and the older old, two patient groups responsible for most medical surge after a disaster. To understand how to ameliorate this surge, we examined the activities of the nine US Department of Veterans Affairs Home-Based Primary Care programs during the 2017 Atlantic Hurricane Season. These and similar programs under Medicare connect the homebound to the healthcare community. Study findings support early implementation of preparedness procedures and intense post-Hurricane patient tracking as a means of limiting reductions in care and preventing significant disruptions to patient health. Engaging with home-based primary care programs during disasters is central to bolstering community resilience for these at-risk populations.

scholarly journals Informal and formal care infrastructure and perceived need for caregiver training for frail US veterans referred to home and community-based services

2010 ◽  
Vol 6 (1) ◽  
pp. 57-66 ◽  
Author(s):  
Courtney Harold Van Houtven ◽  
Eugene Z. Oddone ◽  
Morris Weinberger
Keyword(s):  
Primary Care ◽  
Informal Care ◽  
Medical Center ◽  
Caregiver Training ◽  
Community Based ◽  
Home Health Services ◽  
Home Based ◽  
Chi Squared ◽  
Us Veterans ◽  
Community Based Services

Objectives: To describe the informal care network of US veterans referred to home and community-based services (Homemaker Home Health services, H/HHA, or Home-Based Primary Care, HBPC) at the Durham Veterans Affairs Medical Center (VAMC), including: quantity and types of tasks provided and desired content for caregiver training programs. Methods: All primary care patients referred to H/HHA or HBPC during the preceding 3 months were sent questionnaires in May 2007. Additionally, caregivers were sent questionnaires if a patient gave permission. Descriptive statistics and chi-squared tests were performed. Results: On average, patients received 5.6 hours of VA care and 47 hours of informal care per week. 26% of patients (38% of patients with caregiver proxy respondents) and 59% of caregivers indicated the caregiver would be interested in participating in a training program by phone or on-site. Significant barriers to participation existed. The most common barriers were: transportation; no time due to caregiving or work demands; caregiver’s own health limitations; and no need. Conclusions: Caregiver training needs to be tailored to overcome barriers to participate. Overcoming these barriers may be possible through in-home phone or internet training outside traditional business hours, and by tailoring training to accommodate limiting health problems among caregivers.

scholarly journals Preparedness and response activities of the US Department of Veterans Affairs (VA) home-based primary care program around the fall 2017 hurricane season

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tamar Wyte-Lake ◽  
Claudia Der-Martirosian ◽  
Karen Chu ◽  
Rachel Johnson-Koenke ◽  
Aram Dobalian
Keyword(s):  
Primary Care ◽  
Large Scale ◽  
Care Program ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Home Based Primary Care ◽  
Home Based ◽  
Early Implementation ◽  
Hurricane Season ◽  
At Risk Populations

Abstract Background Large-scale natural disasters disproportionally affect both the medically complex and the older old, groups that are responsible for most medical surge after a disaster. To understand how to ameliorate this surge, we examined the activities of the nine US Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) programs impacted during the 2017 Fall Hurricane Season. Methods Convergent mixed methods design, incorporating independently conducted qualitative and quantitative analyses. Phase One: 34 clinical staff were interviewed from the nine VA HBPC programs impacted by Hurricanes Harvey, Irma, and Maria to examine the experiences of their HBPC programs in response to the Hurricanes. Phase Two: Secondary quantitative data analysis used the VA’s Corporate Data Warehouse (CDW) to examine the electronic health records of patients for these same nine sites. Results The emergency management activities of the HBPC programs emerged as two distinct phases: preparedness, and response and recovery. The early implementation of preparedness procedures, and coordinated post-Hurricane patient tracking, limited disruption in care and prevented significant hospitalizations among this population. Conclusions Individuals aged 75 or older, who often present with multiple comorbidities and decreased functional status, typically prefer to age in their homes. Additionally, as in-home medical equipment evolves, more medically vulnerable individuals are able to receive care at home. HBPC programs, and similar programs under Medicare, connect the homebound, medically complex, older old to the greater healthcare community. Engaging with these programs both pre- and post-disasters is central to bolstering community resilience for these at-risk populations.

scholarly journals Management strategies for chronic rhinosinusitis: a qualitative study of GP and ENT specialist views of current practice in the UK

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022643 ◽  
Author(s):  
Jane Vennik ◽  
Caroline Eyles ◽  
Mike Thomas ◽  
Claire Hopkins ◽  
Paul Little ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Treatment ◽  
Chronic Rhinosinusitis ◽  
Secondary Care ◽  
Nasal Polyps ◽  
Patient Choice ◽  
Care Pathways ◽  
Telephone Interviews ◽  
Best Management ◽  
The Uk

ObjectivesTo explore general practitioner (GP) and ears, nose and throat (ENT) specialist perspectives of current treatment strategies for chronic rhinosinusitis (CRS) and care pathways through primary and secondary care.DesignSemi-structured qualitative telephone interviews as part of the MACRO programme (Defining best Management for Adults with Chronic Rhinosinusitis)SettingPrimary care and secondary care ENT outpatient clinics in the UK.ParticipantsTwelve GPs and 9 ENT specialists consented to in-depth telephone interviews. Transcribed recordings were managed using NVivo software and analysed using inductive thematic analysis.Main outcome measuresHealthcare professional views of management options and care pathways for CRS.ResultsGPs describe themselves as confident in recognising CRS, with the exception of assessing nasal polyps. In contrast, specialists report common missed diagnoses (eg, allergy; chronic headache) when patients are referred to ENT clinics, and attribute this to the limited ENT training of GPs. Steroid nasal sprays provide the foundation of treatment in primary care, although local prescribing restrictions can affect treatment choice and poor adherence is perceived to be the causes of inadequate symptom control. Symptom severity, poor response to medical treatment and patient pressure drive referral, although there is uncertainty about optimal timing. Treatment decisions in secondary care are based on disease severity, polyp status, prior medical treatment and patient choice, but there is major uncertainty about the place of longer courses of antibiotics and the use of oral steroids. Surgery is regarded as an important treatment option for patients with severe symptoms or with nasal polyps, although timing of surgery remains unclear, and the uncertainty about net long-term benefits of surgery makes balancing of benefits and risks more difficult.ConclusionsClinicians are uncertain about best management of patients with CRS in both primary and secondary care and practice is varied. An integrated care pathway for CRS is needed to improve patient management and timely referral.

scholarly journals Adaptations to In-Home Health Care Due to COVID-19: The VA’s Home-Based Primary Care Program

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 467-467
Author(s):  
Leah Haverhals ◽  
Chelsea Manheim ◽  
Nelly Solorzano ◽  
Suzanne Gillespie ◽  
Tamar Wyte-Lake
Keyword(s):  
Primary Care ◽  
Home Health Care ◽  
Qualitative Content Analysis ◽  
Care Delivery ◽  
Care Program ◽  
Department Of Veterans Affairs ◽  
Face To Face ◽  
Home Based Primary Care ◽  
Home Based ◽  
Primary Care Program

Abstract The COVID-19 pandemic disrupted traditional Home Based Primary Care (HBPC) care processes, including changes to provision of face-to-face care in-home for older adults. Our study describes and explains care delivery changes Department of Veterans Affairs (VA) HBPC programs made in response to the pandemic. We fielded a national survey to all 140 VA HBPC programs, targeting interdisciplinary care teams and HBPC leadership. We structured survey questions using a mixed method approach with both closed and open-ended questions, applying a qualitative content analysis approach to open-ended responses complemented by analysis of descriptive quantitative data. Preliminary findings highlight the value and consideration of different telehealth modalities when caring for an older, homebound population, as well as creative adaptations HBPC teams made to deliver care during the pandemic. Implications include nascent development of decision-making paradigms beyond the pandemic particularly for appropriate use of telehealth modalities for older homebound adults.

Dedicated to the Mission: Strategies US Department of Veterans Affairs Home‐Based Primary Care Teams Apply to Keep Veterans at Home

2019 ◽  
Vol 67 (12) ◽  
pp. 2511-2518 ◽  
Author(s):  
Leah M. Haverhals ◽  
Chelsea Manheim ◽  
Carrie Gilman ◽  
Jurgis Karuza ◽  
Tobie Olsan ◽  
...  
Keyword(s):  
Primary Care ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Home Based Primary Care ◽  
Home Based ◽  
Primary Care Teams ◽  
At Home

scholarly journals Impact of Social Isolation Due to COVID-19 on VA Home-Based Primary Care Veterans and Caregivers

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 579-579
Author(s):  
Chelsea Manheim ◽  
Nelly Solorzano ◽  
Juli Barnard ◽  
Tamar Wyte-Lake ◽  
Leah Haverhals
Keyword(s):  
Primary Care ◽  
Social Isolation ◽  
Assisted Living ◽  
Care Delivery ◽  
Veterans Affairs ◽  
Assisted Living Facilities ◽  
Department Of Veterans Affairs ◽  
Home Based Primary Care ◽  
Home Based ◽  
Virtual Visits

Abstract In December 2020 we began conducting phone interviews with Veterans, and their caregivers, receiving care through the United Sates (US) Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) program. Our goal was to describe experiences of Veterans and caregivers managing changes in care delivery related to the COVID-19 pandemic and navigating increased social isolation due to social distancing. We interviewed 38 Veterans (average age 78) and caregivers (average age 62) across seven VA HBPC programs. Findings showed those living in their own homes found increased isolation more manageable than those living in assisted living facilities, which restricted visitors. Caregivers had a harder time managing isolation than Veterans, as Veterans were used to being primarily homebound. Veterans and caregivers relied on increased phone communication with their HBPC teams, with some began participating in virtual visits. Implications include insights into better supporting older, homebound adults and their caregivers during disasters.

Sign in / Sign up

Export Citation Format

Share Document