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Sheinfil AZ, Day G, Walder A, Hogan J, Giordano TP, Lindsay J, Ecker A. Rural Veterans with HIV and Alcohol Use Disorder receive less video telehealth than urban Veterans. J Rural Health 2024; 40:419-429. [PMID: 37759376 PMCID: PMC10965503 DOI: 10.1111/jrh.12799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Alcohol use disorder (AUD) is highly prevalent among Veterans with HIV. Rural Veterans with HIV are at especially high risk for not receiving appropriate treatment. This retrospective cohort cross-sectional study aimed to investigate patterns of mental health treatment utilization across delivery modality among Veterans diagnosed with HIV and AUD. It was hypothesized that rural Veterans with HIV and AUD would receive a lower rate of mental health treatment delivered via video telehealth than urban Veterans with HIV and AUD. METHODS A national Veterans Health Association administrative database was used to identify a cohort of Veterans diagnosed with HIV and AUD (N = 2,075). Geocoding was used to categorize rural Veterans (n = 246) and urban Veterans (n = 1,829). Negative binomial regression models tested associations between rurality and mental health treatment delivered via face-to-face, audio-only, and video telehealth modalities. FINDINGS Results demonstrated that rural Veterans with HIV and AUD received fewer mental health treatment sessions delivered via telehealth than urban Veterans with HIV and AUD (incidence rate ratio = 0.62; 95% confidence intervals [0.44, 0.87]; P < .01). No differences were found in terms of treatment delivered face-to-face or by audio-only. CONCLUSIONS Rural Veterans with HIV and AUD represent a vulnerable subpopulation of Veterans who may most benefit from video telehealth. Efforts to increase access and improve the uptake of evidence-based mental health treatment delivered via video telehealth are needed.
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Affiliation(s)
- Alan Z Sheinfil
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Giselle Day
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Annette Walder
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Julianna Hogan
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas P. Giordano
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jan Lindsay
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- Rice University’s Baker Institute for Public Policy, Houston, Texas, USA
| | - Anthony Ecker
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
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Boudreau JH, Moo LR, Kennedy MA, Conti J, Anwar C, Pimentel CB, Nearing KA, Hung WW, Dryden EM. Needs for Successful Engagement in Telemedicine Among Rural Older US Veterans and Their Caregivers: Qualitative Study. JMIR Form Res 2024; 8:e50507. [PMID: 38713503 PMCID: PMC11109863 DOI: 10.2196/50507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/15/2024] [Accepted: 03/13/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Telemedicine is an important option for rural older adults who often must travel far distances to clinics or forgo essential care. In 2014, the Geriatric Research, Education, and Clinical Centers (GRECC) of the US Veterans Health Administration (VA) established a national telemedicine network called GRECC Connect. This network increased access to geriatric specialty care for the 1.4 million rural VA-enrolled veterans aged 65 years or older. The use of telemedicine skyrocketed during the COVID-19 pandemic, which disproportionately impacted older adults, exacerbating disparities in specialty care access as overburdened systems shut down in-person services. This surge presented a unique opportunity to study the supports necessary for those who would forgo telemedicine if in-person care were available. OBJECTIVE In spring 2021, we interviewed veterans and their informal caregivers to (1) elicit their experiences attempting to prepare for a video visit with a GRECC Connect geriatric specialist and (2) explore facilitators and barriers to successful engagement in a telemedicine visit. METHODS We conducted a cross-sectional qualitative evaluation with patients and their caregivers who agreed to participate in at least 1 GRECC Connect telemedicine visit in the previous 3 months. A total of 30 participants from 6 geographically diverse GRECC Connect hub sites agreed to participate. Semistructured interviews were conducted through telephone or the VA's videoconference platform for home telemedicine visits (VA Video Connect) per participant preference. We observed challenges and, when needed, provided real-time technical support to facilitate VA Video Connect use for interviews. All interviews were recorded with permission and professionally transcribed. A team of 5 researchers experienced in qualitative research analyzed interview transcripts using rapid qualitative analysis. RESULTS From 30 participant interviews, we identified the following 4 categories of supports participants described regarding successful engagement in telemedicine, as defined by visit completion, satisfaction, and willingness to engage in telemedicine in the future: (1) caregiver presence to facilitate technology setup and communication; (2) flexibility in visit modality (eg, video from home or a clinic or telephone); (3) technology support (eg, determining device compatibility or providing instruction and on-demand assistance); and (4) assurance of comfort with web-based communication, including orientation to features like closed captioning. Supports were needed at multiple points before the visit, and participants stressed the importance of eliciting the varying needs and preferences of each patient-caregiver dyad. Though many initially agreed to a telemedicine visit because of pandemic-related clinic closures, participants were satisfied with telemedicine and willing to use it for other types of health care visits. CONCLUSIONS To close gaps in telemedicine use among rural older adults, supports must be tailored to individuals, accounting for technology availability and comfort, as well as availability of and need for caregiver involvement. Comprehensive scaffolding of support starts well before the first telemedicine visit.
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Affiliation(s)
- Jacqueline Hannah Boudreau
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
| | - Lauren R Moo
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Meaghan A Kennedy
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
- Department of Family Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Jennifer Conti
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
| | - Chitra Anwar
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
| | - Camilla B Pimentel
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Kathryn A Nearing
- Eastern Colorado VA Geriatric Research Education and Clinical Center, Aurora, CO, United States
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - William W Hung
- Bronx Geriatric Research Education and Clinical Center, James J Peters VA Medical Center, Bronx, New York, NY, United States
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, NY, United States
| | - Eileen M Dryden
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
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Gujral K, Van Campen J, Jacobs J, Lo J, Kimerling R, Blonigen DM, Wagner TH, Zulman DM. Sociodemographic Differences in the Impacts of Video-Enabled Tablets on Psychotherapy Usage Among Veterans. Psychiatr Serv 2024; 75:434-443. [PMID: 38088041 DOI: 10.1176/appi.ps.20230134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To examine potential health disparities due to a broad reliance on telehealth during the COVID-19 pandemic, the authors studied the impact of video-enabled tablets provided by the U.S. Department of Veterans Affairs (VA) on psychotherapy usage among rural versus urban, Black versus White, and female versus male veterans. METHODS Psychotherapy usage trends before and after onset of the COVID-19 pandemic were examined among veterans with at least one mental health visit in 2019 (63,764 tablet recipients and 1,414,636 nonrecipients). Adjusted difference-in-differences and event study analyses were conducted to compare psychotherapy usage among tablet recipients and nonrecipients (March 15, 2020-December 31, 2021) 10 months before and after tablet issuance. Analyses were stratified by rurality, sex, and race. RESULTS Adjusted analyses demonstrated that tablet receipt was associated with increases in psychotherapy visit frequency in every patient group studied (rural, 27.4%; urban, 24.6%; women, 30.5%; men, 24.4%; Black, 20.8%; White, 28.1%), compared with visits before tablet receipt. Compared with men, women had statistically significant tablet-associated psychotherapy visit increases (video visits, 1.2 per year; all modalities, 1.0 per year). CONCLUSIONS VA-issued tablets led to increased psychotherapy usage for all groups examined, with similar increases found for rural versus urban and Black versus White veterans and higher increases for women versus men. Eliminating barriers to Internet access or device ownership may improve mental health care access among underserved or historically disadvantaged populations. VA's tablet program offers insights to inform policy makers' and health systems' efforts to bridge the digital divide.
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Affiliation(s)
- Kritee Gujral
- Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford
| | - James Van Campen
- Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford
| | - Josephine Jacobs
- Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford
| | - Jeanie Lo
- Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford
| | - Rachel Kimerling
- Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford
| | - Daniel M Blonigen
- Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford
| | - Todd H Wagner
- Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford
| | - Donna M Zulman
- Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford
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Schmidt SA. Teletherapy Used to Breakdown Access Barriers. Telemed J E Health 2024; 30:1491-1494. [PMID: 38190285 DOI: 10.1089/tmj.2023.0612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
The studies presented in this literature review reveal the numerous ways that teletherapy can be used to treat patients with mental health issues. The literature includes six research articles from published scientific journals that span from 2005 to 2020. The three types of telehealth therapy reviewed include mobile telehealth, telephone, and video technology. The six research articles focus on the ways that telehealth can reach communities of lower socioeconomic status (SES) and those suffering from access barriers. The benefits of teletherapy include cost savings, time efficiency, easier access, and a reduction in recidivism. Challenges include access barriers, financial difficulties, anxiety, and fear of stigmatization. Limitations of the studies presented include a lack of accessibility to internet and technology, privacy issues, and insurance coverage. Overall, results show that teletherapy provides an affordable, accessible alternative to traditional in-person mental health therapy, especially in reaching lower SES groups, Veterans, and patients with access restrictions.
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Affiliation(s)
- Sarah A Schmidt
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
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Slightam C, SooHoo S, Greene L, Zulman DM, Kimerling R. Development and Validation of a Measure to Assess Patient Experiences With Video Care Encounters. JAMA Netw Open 2024; 7:e245277. [PMID: 38578639 PMCID: PMC10998154 DOI: 10.1001/jamanetworkopen.2024.5277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024] Open
Abstract
Importance As video-based care expands in many clinical settings, assessing patient experiences with this care modality will help optimize health care quality, safety, and communication. Objective To develop and assess the psychometric properties of the video visit user experience (VVUE) measure, a patient-reported measure of experiences with video-based technology. Design, Setting, and Participants In this survey study, veterans completed a web-based, mail, or telephone survey about their use of Veterans Healthcare Administration (VHA) virtual care between September 2021 and January 2022. The survey was completed by patients who reported having a VHA video visit on their own device or a VHA-issued device and linked to VHA utilization data for the 6 months following the survey. Data analysis was performed from March 2022 to February 2023. Main Outcomes and Measures The survey included 19 items about experiences with video visits that were rated using a 4-point Likert-type scale (strongly disagree to strongly agree). First, an exploratory factor analysis was conducted to determine the factor structure and parsimonious set of items, using the McDonald Omega test to assess internal consistency reliability. Then, a confirmatory factor analysis was conducted to test structural validity, and bivariate correlations between VVUE and VHA health care engagement were calculated to test concurrent validity. Finally, predictive validity was assessed using logistic regression to determine whether VVUE was associated with future VHA video visit use. Results Among 1887 respondents included in the analyses, 83.2% (95% CI, 81.5%-84.8%) were male, 41.0% (95% CI, 38.8%-43.1%) were aged 65 years or older, and the majority had multiple chronic medical and mental health conditions. The exploratory factor analysis identified a 10-item single-factor VVUE measure (including questions about satisfaction, user-centeredness, technical quality, usefulness, and appropriateness), explaining 96% of the total variance, with acceptable internal consistency reliability (ω = 0.95). The confirmatory factor analysis results confirmed a single-factor solution (standardized root mean squared residual = 0.04). VVUE was positively associated with VHA health care engagement (ρ = 0.47; P < .001). Predictive validity models demonstrated that higher VVUE measure scores were associated with future use of video visits, where each 1-point increase on VVUE was associated with greater likelihood of having a video visit in subsequent 6 months (adjusted odds ratio, 1.04; 95% CI, 1.02-1.06). Conclusions and Relevance The findings of this study of veterans using video visits suggest that a brief measure is valid to capture veterans' experiences receiving VHA virtual care.
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Affiliation(s)
- Cindie Slightam
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Sonya SooHoo
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Liberty Greene
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Donna M. Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Rachel Kimerling
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
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Alfaro AJ, Greene L, Van Campen J, Zulman DM, Gould CE, Blonigen DM. Patterns and predictors of mental health service use among older veterans with alcohol use disorder who received a video-enabled tablet. Aging Ment Health 2024; 28:604-610. [PMID: 37723897 DOI: 10.1080/13607863.2023.2253448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023]
Abstract
Objectives: Video-based telehealth may expand access to mental health services among older veterans with alcohol use disorder (AUD). We examined the modalities through which mental health services were rendered, and predictors of video visits before and after video-enabled tablet receipt from the Veterans Health Administration. Method: 11,210 veterans aged 60 or older with a diagnosis of AUD who received a tablet between 1 April 2020 and 25 October 2021 were identified. The electronic health record was used to characterized encounters by modality of mental health care delivery in the six months pre/post tablet receipt. Logistic regression examined predictors of a video visit for mental health. Results: Phone was the most common modality; however, the proportion of video encounters increased from 8.7% to 26.2% after tablet receipt. Individuals who were older, male, and had more physical health conditions, were less likely to have a video visit. Individuals who were married, resided in urban areas, had a history of housing instability, and had more mental health conditions, were more likely to have a video visit. Conclusion: Video-enabled tablets may help older adults with AUD overcome access barriers to mental health services, although targeted support for certain groups may be necessary.
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Affiliation(s)
- Ana J Alfaro
- VA Palo Alto Health Care System, Geriatric Research, Education and Clinical Center (GRECC), Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Services, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Liberty Greene
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - James Van Campen
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Donna M Zulman
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Christine E Gould
- VA Palo Alto Health Care System, Geriatric Research, Education and Clinical Center (GRECC), Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Services, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Daniel M Blonigen
- Department of Psychiatry and Behavioral Services, Stanford University School of Medicine, Palo Alto, CA, USA
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA
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Gately ME, Waller DE, Metcalf EE, Moo LR. Caregivers' Role in In-Home Video Telehealth: National Survey of Occupational Therapy Practitioners. JMIR Rehabil Assist Technol 2024; 11:e52049. [PMID: 38483462 PMCID: PMC10979337 DOI: 10.2196/52049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/20/2023] [Accepted: 01/12/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Older adults face barriers to specialty care, such as occupational therapy (OT), and these challenges are worse for rural older adults. While in-home video telehealth may increase access to OT, older adults' health- and technology-related challenges may necessitate caregiver assistance. OBJECTIVE This study examines caregiver assistance with in-home OT video telehealth visits from the perspectives of OT practitioners at Veterans Health Administration (VHA). METHODS A web-based national survey of VHA OT practitioners about caregivers' role in video telehealth was conducted between January and February 2022. Survey items were developed with input from subject matter experts in geriatrics and OT and identified patient factors that necessitate caregiver participation; the extent to which caregivers assist with different types of tasks (technological and clinical tasks); and the perceived facilitators of, benefits of, and barriers to caregiver involvement. RESULTS Of approximately 1787 eligible VHA OT practitioners, 286 (16% response rate) participated. Not all survey items required completion, resulting in different denominators. Most respondents were female (183/226, 81%), White (163/225, 72.4%), and occupational therapists (275/286, 96.2%). Respondents were from 87 VHA medical centers, the catchment areas of which served a patient population that was 34% rural, on average (SD 0.22). Most participants (162/232, 69.8%) had >10 years of OT experience serving a patient cohort mostly aged ≥65 years (189/232, 81.5%) in primarily outpatient rehabilitation (132/232, 56.9%). The top patient factors necessitating caregiver involvement were lack of technical skills, cognitive impairment, and advanced patient age, with health-related impairments (eg, hearing or vision loss) less frequent. Technological tasks that caregivers most frequently assisted with were holding, angling, moving, repositioning, or operating the camera (136/250, 54.4%) and enabling and operating the microphone and setting the volume (126/248, 50.8%). Clinical tasks that caregivers most frequently assisted with were providing patient history (143/239, 59.8%) and assisting with patient communication (124/240, 51.7%). The top facilitator of caregiver participation was clinician-delivered caregiver education about what to expect from video telehealth (152/275, 55.3%), whereas the top barrier was poor connectivity (80/235, 34%). Increased access to video telehealth (212/235, 90.2%) was the top-rated benefit of caregiver participation. Most respondents (164/232, 70.7%) indicated that caregivers were at least sometimes unavailable or unable to assist with video telehealth, in which case the appointment often shifted to phone. CONCLUSIONS Caregivers routinely assist VHA patients with in-home OT video visits, which is invaluable to patients who are older and have complex medical needs. Barriers to caregiver involvement include caregivers' challenges with video telehealth or inability to assist, or lack of available caregivers. By elucidating the caregiver support role in video visits, this study provides clinicians with strategies to effectively partner with caregivers to enhance older patients' access to video visits.
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Affiliation(s)
- Megan Elizabeth Gately
- VA Bedford Health Care System, Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, United States
- Boston University School of Medicine, Division of Geriatrics, Boston, MA, United States
| | - Dylan E Waller
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, United States
| | - Emily E Metcalf
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, United States
- Oregon Medical Research Center, Portland, OR, United States
| | - Lauren R Moo
- VA Bedford Health Care System, Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, United States
- Massachusetts General Hospital, Cognitive Behavioral Neurology Unit, Boston, MA, United States
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Santos J, Camplain C, Pollitt AM, Baldwin JA. A formative assessment of client characteristics associated with missed appointments in integrated primary care services in rural Arizona. J Eval Clin Pract 2024; 30:243-250. [PMID: 37933799 DOI: 10.1111/jep.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Integrating primary care services in mental healthcare facilities is an uncommon model of care in the United States that could bring several benefits (e.g., improved access to physical healthcare) for vulnerable populations experiencing mental health conditions, especially those living in underserved regions like rural Arizona. AIM This formative assessment aimed to understand the sociodemographic and clinical characteristics of clients accessing integrated primary care (IPC) services implemented in 2021 at a community mental healthcare facility in rural Arizona and to explore the proportion of missed appointments. Additionally, we analysed the association between client characteristics and IPC missed appointments. METHODS The authors collaborated with a community mental health facility in rural Arizona, which provided deidentified data from 280 clients who accessed IPC services from June 2021 to February 2022. RESULTS Most clients were White and of vulnerable socioeconomic status, with a substantial proportion of Native Americans (23.58%). The majority of clients (55.75%) had a mental health disorder (MHD), 23.74% had a substance use disorder (SUD), and 15.10% had comorbid MHD and SUD. Linear regression revealed that experiencing comorbid MHD and SUD was significantly associated with missed appointments. Compared with White clients, Native Americans missed fewer appointments. CONCLUSION Future studies conducted from a culturally-centred perspective are crucial to guide strategies to reduce missed appointments in rural IPC services.
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Affiliation(s)
- Jeffersson Santos
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Carolyn Camplain
- Department of Community and Population Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Amanda Marie Pollitt
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Julie Ann Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
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Heyworth L, Shah N, Galpin K. 20 Years of Telehealth in the Veterans Health Administration: Taking Stock of Our Past and Charting Our Future. J Gen Intern Med 2024; 39:5-8. [PMID: 38378981 PMCID: PMC10937874 DOI: 10.1007/s11606-024-08617-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, 810 Vermont Avenue, Washington, NW, DC 20420, USA.
| | - Nilesh Shah
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, 810 Vermont Avenue, Washington, NW, DC 20420, USA
| | - Kevin Galpin
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, 810 Vermont Avenue, Washington, NW, DC 20420, USA
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Dhanani Z, Ferguson JM, Van Campen J, Slightam C, Heyworth L, Zulman DM. Adoption and Sustained Use of Primary Care Video Visits Among Veterans with VA Video-Enabled Tablets. J Med Syst 2024; 48:16. [PMID: 38289373 DOI: 10.1007/s10916-024-02035-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
In 2020, the U.S. Department of Veterans Affairs (VA) expanded an initiative to distribute video-enabled tablets to Veterans with limited virtual care access. We examined patient characteristics associated with adoption and sustained use of video-based primary care among Veterans. We conducted a retrospective cohort study of Veterans who received VA-issued tablets between 3/11/2020-9/10/2020. We used generalized linear models to evaluate the sociodemographic and clinical factors associated with video-based primary care adoption (i.e., likelihood of having a primary care video visit) and sustained use (i.e., rate of video care) in the six months after a Veteran received a VA-issued tablet. Of the 36,077 Veterans who received a tablet, 69% had at least one video-based visit within six months, and 24% had a video-based visit in primary care. Veterans with a history of housing instability or a mental health condition, and those meeting VA enrollment criteria for low-income were significantly less likely to adopt video-based primary care. However, among Veterans who had a video visit in primary care (e.g., those with at least one video visit), older Veterans, and Veterans with a mental health condition had more sustained use (higher rate) than younger Veterans or those without a mental health condition. We found no differences in adoption of video-based primary care by rurality, age, race, ethnicity, or low/moderate disability and high disability priority groups compared to Veterans with no special enrollment category. VA's tablet initiative has supported many Veterans with complex needs in accessing primary care by video. While Veterans with certain social and clinical challenges were less likely to have a video visit, those who adopted video telehealth generally had similar or higher rates of sustained use. These patterns suggest opportunities for tailored interventions that focus on needs specific to initial uptake vs. sustained use of video care.
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Affiliation(s)
- Zainub Dhanani
- Department of Health Policy, Stanford University School of Medicine, 290 Campus Dr, Stanford, CA, 94305, USA.
| | - Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - James Van Campen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
| | - Cindie Slightam
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
| | - Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, Washington, DC, USA
- Department of Medicine, UC San Diego School of Medicine, San Diego, CA, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Krohner S, Town J, Cannoy CN, Schubiner H, Rapport LJ, Grekin E, Lumley MA. Emotion-Focused Psychodynamic Interview for People with Chronic Musculoskeletal Pain and Childhood Adversity: A Randomized Controlled Trial. THE JOURNAL OF PAIN 2024; 25:39-52. [PMID: 37479050 DOI: 10.1016/j.jpain.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/25/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
Childhood adversity and emotional conflicts are associated with the presence and severity of chronic musculoskeletal pain (CMP), yet common treatments for CMP do not address such risk factors. We developed a single session, emotion-focused psychodynamic interview, based on Emotional Awareness and Expression Therapy and Intensive Short-term Psychodynamic Therapy, and we tested the interview's effects on pain-related outcomes and potential psychological mediators in a randomized, controlled trial. Adults (N = 91; ages 21-70, M = 44.64; 87.9% women) reporting CMP and at least 3 adverse childhood experiences completed measures at baseline and 6-week follow-up. Participants were randomized to immediate interview or waitlist control conditions. The 90-minute interview was conducted via videoconference, and the interviewer elicited disclosure of adversities and conflicts, linked these with pain, and encouraged the experience and expression of adaptive emotions. Analyses indicated that conditions did not differ significantly on change in pain severity; however, compared to control, the interview led to a significantly greater reduction in pain interference (P = .016, ηp2 = .05) and a similar trend for anxiety (P = .058, ηp2 = .04). The interview also significantly changed several potential mediators: pain-related anxiety (P = .008, ηp2 = .06), pain controllability (P = .016, ηp2 = .06), and psychological (P < .001, ηp2 = .15) and brain attributions (P = .022, ηp2 = .05) for pain. Participants viewed the interview as very valuable. We conclude that addressing childhood adversities and conflicts in a psychodynamic interview is beneficial for people with CMP. PERSPECTIVE: This study found that, compared to waitlist control, a 90-minute, remotely-administered, emotion-focused, psychodynamic interview improved pain interference, and anxiety among adults with chronic musculoskeletal pain and childhood adversity. Intensive emotional work can be done in a single session to the benefit of patients with chronic musculoskeletal pain.
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Affiliation(s)
- Shoshana Krohner
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - Joel Town
- Centre for Emotions & Health, Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Ciara N Cannoy
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - Howard Schubiner
- Department of Internal Medicine, Ascension Health / Providence Park Hospital, Michigan State University, Southfield, Michigan
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - Emily Grekin
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan
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Gately ME, Trudeau SA. An Online Learning Experience Simulating Video Telehealth with Older Adults: Student Perceptions. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2023; 9:154-163. [PMID: 38586236 PMCID: PMC10996448 DOI: 10.1007/s41347-023-00363-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 04/09/2024]
Abstract
Older adults are an underserved population with a broad-spectrum of care needs due to multi-morbidity, including increasing rates of mental health conditions. Though a prime target for tele-behavioral health due to access barriers, older adults face a persistent digital divide that necessitates clinician training and education to ensure interprofessional tele-behavioral health is tailored to their needs. This paper presents findings from a simulation learning program designed to teach students about the role of video telehealth with populations with diverse needs. Occupational therapy (OT) students enrolled in a Master's program between 2017 and 2018 conducted a simulated video telehealth session geared for an older adult. Sessions were recorded and annotated by students, who then provided feedback on their experience of the simulation via reflective essays (N = 27). Essays were analyzed using conventional content analysis with themes revealing the benefits of simulation in providing students with an opportunity to experience the often unpredictable nature of video telehealth. Themes also revealed perceived limitations of video and the negative impact of age-related conditions and age itself on older adults' ability to engage in video, reflecting ageist stereotyping and bias as potential barriers to novice practitioners' integration of video telehealth with older adults. Simulation provides students an opportunity to engage in active learning and problem-solving in the moment, fostering students' development of clinical reasoning while promoting reflective practice. Findings reveal the importance of supporting students' recognition of biased attitudes to ensure equitable application of tele-behavioral health care, especially to populations with complex needs.
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Affiliation(s)
- Megan E. Gately
- Geriatric Research Education and Clinical Center, VA; Bedford Health Care System, Bedford, MA, USA
- Department of Occupational Therapy, Tufts University, Medford, MA, USA
| | - Scott A. Trudeau
- Geriatric Research Education and Clinical Center, VA; Bedford Health Care System, Bedford, MA, USA
- Department of Occupational Therapy, Tufts University, Medford, MA, USA
- American Occupational Therapy Association, Bethesda, MD, USA
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13
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Portnoy GA, Relyea MR, Presseau C, Orazietti SA, Bruce LE, Brandt CA, Martino S. Screening for Intimate Partner Violence Experience and Use in the Veterans Health Administration. JAMA Netw Open 2023; 6:e2337685. [PMID: 37831451 PMCID: PMC10576210 DOI: 10.1001/jamanetworkopen.2023.37685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/01/2023] [Indexed: 10/14/2023] Open
Abstract
Importance The practice of screening women for intimate partner violence (IPV) in health care settings has been a critical part of responding to this major public health problem. Yet, IPV prevention would be enhanced with detection efforts that extend beyond screening for IPV experiences to identifying those who use violence in relationships as well. Objective To determine rates of IPV experiences and use (ie, among perpetrators of IPV) and factors associated with disclosures among adult patients seeking mental health services at the Veterans Health Administration. Design, Setting, and Participants This cross-sectional study used electronic medical record data drawn from a quality improvement initiative at 5 Veterans Health Administration medical centers conducted between November 2021 and February 2022 to examine IPV disclosures following concurrent screening for IPV experience and use. Participants included patients engaged in mental health services. Data were analyzed in April and May 2023. Exposure Mental health clinicians were trained to screen for IPV experience and use concurrently and instructed to screen all patients encountered through routine mental health care visits during a 3-month period. Main Outcomes and Measures Outcomes of interest were past-year prevalence of IPV use and experience, sociodemographic characteristics, and clinical diagnoses among screened patients. Results A total of 200 patients were offered IPV screening. Of 155 participants (mean [SD] age, 52.45 [15.65] years; 124 [80.0%] men) with completed screenings, 74 (47.7%) denied past-year IPV experience and use, 76 (49.0%) endorsed past-year IPV experience, and 72 (46.4%) endorsed past-year IPV use, including 67 participants (43.2%) who reported IPV experience and use concurrently; only 9 participants (5.8%) endorsed unidirectional IPV experiences and 5 participants (3.2%) endorsed unidirectional IPV use. Patients who reported past-year IPV experience and use were younger than those who denied IPV (experience: mean difference, -7.34 [95% CI, 2.51-12.17] years; use: mean difference, -7.20 [95% CI, 2.40-12.00] years). Patients with a posttraumatic stress disorder diagnosis were more likely to report IPV use (43 patients [59.7%]) than those without a posttraumatic stress disorder diagnosis (29 patients [40.3%]; odds ratio, 2.14; [95% CI, 1.12-4.06]). No other demographic characteristics or clinical diagnoses were associated with IPV use or experience. Conclusions and Relevance In this cross-sectional study of IPV rates and associated factors, screening for IPV found high rates of both IPV experience and use among patients receiving mental health care. These findings highlight the benefit of screening for IPV experience and use concurrently across gender and age. Additionally, the associations found between PTSD and IPV use underscore the importance of strengthening and developing additional targeted treatment for IPV.
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Affiliation(s)
- Galina A. Portnoy
- VA Connecticut Healthcare System, West Haven
- Yale School of Medicine, New Haven, Connecticut
| | - Mark R. Relyea
- VA Connecticut Healthcare System, West Haven
- Yale School of Medicine, New Haven, Connecticut
| | - Candice Presseau
- VA Connecticut Healthcare System, West Haven
- Yale School of Medicine, New Haven, Connecticut
| | | | - LeAnn E. Bruce
- Veterans Healthcare Administration Intimate Partner Violence Assistance Program, Washington, District of Columbia
- Western Kentucky University School of Social Work, Bowling Green
| | - Cynthia A. Brandt
- VA Connecticut Healthcare System, West Haven
- Yale School of Medicine, New Haven, Connecticut
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven
- Yale School of Medicine, New Haven, Connecticut
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Hertz AG, Dawson DB, Rassu FS, Ecker AH, Helm A, Hundt NE, Fletcher TL. Delivery of Exposure and Response Prevention Among Veterans with Obsessive-Compulsive Disorder. J Behav Health Serv Res 2023; 50:514-523. [PMID: 37024645 DOI: 10.1007/s11414-023-09838-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
Veterans with obsessive-compulsive disorder (OCD) often face barriers to receiving evidence-based treatments such as exposure and response prevention (ERP). Through retrospective review of electronic medical records, this study examined the rates of ERP delivery in a national sample of 554 veterans newly diagnosed with OCD in the Veterans Health Administration between 2016 and 2017. Results indicated that only 4% of veterans (n = 22) received any ERP treatment; and, of those, 16 veterans received "true ERP." Veterans who received any ERP were younger than those who did not. ERP was primarily delivered by psychologists in urban facilities along the East and West coasts of the USA. The findings from this study emphasize the need to train more providers to effectively deliver ERP in addition to providing telehealth services to increase access to care for veterans in rural areas.
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Affiliation(s)
- Alyssa G Hertz
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Darius B Dawson
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Fenan S Rassu
- Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anthony H Ecker
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Ashley Helm
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Natalie E Hundt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Terri L Fletcher
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA.
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15
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Loizos M, Baim-Lance A, Ornstein KA, Lubetsky S, Salas-Belkin L, Chavez S, Zhang M, DeCherrie LV, Gliatto PM. If You Give Them Away, It Still May Not Work: Challenges to Video Telehealth Device Use Among the Urban Homebound. J Appl Gerontol 2023; 42:1896-1902. [PMID: 37070328 PMCID: PMC10524114 DOI: 10.1177/07334648231170144] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
The growing homebound population may particularly benefit from video telehealth. However, some patients do not have the ability or resources to successfully use this modality. This report presents the experience of a large urban home-based primary care program disseminating cellular-enabled tablets with basic instruction to a subset of its patients who would not otherwise have had the ability to engage in video telehealth. Program goals included: increasing the number of patients able to engage in video encounters and leveraging technology to help achieve greater equity. While 123 homebound patients received devices for telehealth, only one-third successfully utilized them. We identified multiple barriers to telehealth utilization beyond physical access to a device, including a lack of skill. Efforts to increase video encounters among patient groups who are less experienced with technology cannot simply rely on device provision or basic instruction but must include reinforced learning strategies combined with ongoing technical assistance.
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Affiliation(s)
- Maria Loizos
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Abigail Baim-Lance
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters VA Medical Center, Bronx, NY, USA
| | | | - Sara Lubetsky
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Silvia Chavez
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meng Zhang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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16
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Wright-Berryman J, Cohen J, Haq A, Black DP, Pease JL. Virtually screening adults for depression, anxiety, and suicide risk using machine learning and language from an open-ended interview. Front Psychiatry 2023; 14:1143175. [PMID: 37377466 PMCID: PMC10291825 DOI: 10.3389/fpsyt.2023.1143175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Background Current depression, anxiety, and suicide screening techniques rely on retrospective patient reported symptoms to standardized scales. A qualitative approach to screening combined with the innovation of natural language processing (NLP) and machine learning (ML) methods have shown promise to enhance person-centeredness while detecting depression, anxiety, and suicide risk from in-the-moment patient language derived from an open-ended brief interview. Objective To evaluate the performance of NLP/ML models to identify depression, anxiety, and suicide risk from a single 5-10-min semi-structured interview with a large, national sample. Method Two thousand four hundred sixteen interviews were conducted with 1,433 participants over a teleconference platform, with 861 (35.6%), 863 (35.7%), and 838 (34.7%) sessions screening positive for depression, anxiety, and suicide risk, respectively. Participants completed an interview over a teleconference platform to collect language about the participants' feelings and emotional state. Logistic regression (LR), support vector machine (SVM), and extreme gradient boosting (XGB) models were trained for each condition using term frequency-inverse document frequency features from the participants' language. Models were primarily evaluated with the area under the receiver operating characteristic curve (AUC). Results The best discriminative ability was found when identifying depression with an SVM model (AUC = 0.77; 95% CI = 0.75-0.79), followed by anxiety with an LR model (AUC = 0.74; 95% CI = 0.72-0.76), and an SVM for suicide risk (AUC = 0.70; 95% CI = 0.68-0.72). Model performance was generally best with more severe depression, anxiety, or suicide risk. Performance improved when individuals with lifetime but no suicide risk in the past 3 months were considered controls. Conclusion It is feasible to use a virtual platform to simultaneously screen for depression, anxiety, and suicide risk using a 5-to-10-min interview. The NLP/ML models performed with good discrimination in the identification of depression, anxiety, and suicide risk. Although the utility of suicide risk classification in clinical settings is still undetermined and suicide risk classification had the lowest performance, the result taken together with the qualitative responses from the interview can better inform clinical decision-making by providing additional drivers associated with suicide risk.
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Affiliation(s)
- Jennifer Wright-Berryman
- Department of Social Work, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | | | - Allie Haq
- Clarigent Health, Mason, OH, United States
| | | | - James L. Pease
- Department of Social Work, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
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17
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Lyles CR, Nguyen OK, Khoong EC, Aguilera A, Sarkar U. Multilevel Determinants of Digital Health Equity: A Literature Synthesis to Advance the Field. Annu Rev Public Health 2023; 44:383-405. [PMID: 36525960 PMCID: PMC10329412 DOI: 10.1146/annurev-publhealth-071521-023913] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Current digital health approaches have not engaged diverse end users or reduced health or health care inequities, despite their promise to deliver more tailored and personalized support to individuals at the right time and the right place. To achieve digital health equity, we must refocus our attention on the current state of digital health uptake and use across the policy, system, community, individual, and intervention levels. We focus here on (a) outlining a multilevel framework underlying digital health equity; (b) summarizingfive types of interventions/programs (with example studies) that hold promise for advancing digital health equity; and (c) recommending future steps for improving policy, practice, and research in this space.
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Affiliation(s)
- Courtney R Lyles
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Public Health, University of California-Berkeley, Berkeley, California, USA
| | - Oanh Kieu Nguyen
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- Department of Medicine, Division of Hospital Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Elaine C Khoong
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
| | - Adrian Aguilera
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Social Welfare, University of California-Berkeley, Berkeley, California, USA
- Department of Psychiatry, University of California-San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
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18
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Ferguson JM, Wray CM, Jacobs J, Greene L, Wagner TH, Odden MC, Freese J, Van Campen J, Asch SM, Heyworth L, Zulman DM. Variation in initial and continued use of primary, mental health, and specialty video care among Veterans. Health Serv Res 2023; 58:402-414. [PMID: 36345235 PMCID: PMC10012228 DOI: 10.1111/1475-6773.14098] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To identify which Veteran populations are routinely accessing video-based care. DATA SOURCES AND STUDY SETTING National, secondary administrative data from electronic health records at the Veterans Health Administration (VHA), 2019-2021. STUDY DESIGN This retrospective cohort analysis identified patient characteristics associated with the odds of using any video care; and then, among those with a previous video visit, the annual rate of video care utilization. Video care use was reported overall and stratified into care type (e.g., primary, mental health, and specialty video care) between March 10, 2020 and February 28, 2021. DATA COLLECTION Veterans active in VA health care (>1 outpatient visit between March 11, 2019 and March 10, 2020) were included in this study. PRINCIPAL FINDINGS Among 5,389,129 Veterans in this evaluation, approximately 27.4% of Veterans had at least one video visit. We found differences in video care utilization by type of video care: 14.7% of Veterans had at least one primary care video visit, 10.6% a mental health video visit, and 5.9% a specialty care video visit. Veterans with a history of housing instability had a higher overall rate of video care driven by their higher usage of video for mental health care compared with Veterans in stable housing. American Indian/Alaska Native Veterans had reduced odds of video visits, yet similar rates of video care when compared to White Veterans. Low-income Veterans had lower odds of using primary video care yet slightly elevated rates of primary video care among those with at least one video visit when compared to Veterans enrolled at VA without special considerations. CONCLUSIONS Variation in video care utilization patterns by type of care identified Veteran populations that might require greater resources and support to initiate and sustain video care use. Our data support service specific outreach to homeless and American Indian/Alaska Native Veterans.
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Affiliation(s)
- Jacqueline M. Ferguson
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Charlie M. Wray
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Section of Hospital MedicineVeterans Affairs San Francisco Health Care SystemSan FranciscoCaliforniaUSA
| | - Josephine Jacobs
- Health Economics Resource CenterVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Liberty Greene
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Todd H. Wagner
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Health Economics Resource CenterVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Michelle C. Odden
- Geriatric Research, Education, and Clinical CenterVeterans Affairs Palo Alto Health Care SystemPalo AltoCaliforniaUSA
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Jeremy Freese
- Department of SociologyStanford UniversityStanfordCaliforniaUSA
| | - James Van Campen
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Steven M. Asch
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Leonie Heyworth
- Office of Connected Care/TelehealthDepartment of Veterans Affairs Central OfficeWashingtonDCUSA
- Department of MedicineUniversity of California, San Diego School of MedicineSan DiegoCaliforniaUSA
| | - Donna M. Zulman
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
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19
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Pullyblank K. A Scoping Literature Review of Rural Beliefs and Attitudes toward Telehealth Utilization. West J Nurs Res 2023; 45:375-384. [PMID: 36324263 DOI: 10.1177/01939459221134374] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this scoping literature review was to understand what is known about how the rural profile influences beliefs regarding telehealth utilization. Rural nursing theory (RNT) provided a framework for the review. Search criteria were limited to peer-reviewed studies conducted in Europe, the United States, Canada, Australia, and New Zealand. A variety of search terms related to patient telehealth perceptions generated 213 unique articles, of which 10 met the inclusion criteria. Included studies incorporated qualitative methodologies and were from Australia, Canada, Sweden, or the United States. The review highlighted four themes related to the rural profile's influence on telehealth beliefs: importance of familiar relationships, concerns with privacy and confidentiality, acceptance of limited access to care, and resourcefulness and frugality. These themes echo concepts within RNT. Nurses and other health professionals must acknowledge the rural profile's influence on a person's decision to use telehealth in order to provide optimal care.
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Affiliation(s)
- Kristin Pullyblank
- Bassett Research Institute, Center for Rural Community Health, Cooperstown, NY, USA
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Basch C, Ferguson JM, Van Campen J, Slightam C, Jacobs JC, Heyworth L, Zulman D. Overcoming Access Barriers for Veterans: Cohort Study of the Distribution and Use of Veterans Affairs' Video-Enabled Tablets Before and During the COVID-19 Pandemic. J Med Internet Res 2023; 25:e42563. [PMID: 36630650 PMCID: PMC9912147 DOI: 10.2196/42563] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/11/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, as health care services shifted to video- and phone-based modalities for patient and provider safety, the Veterans Affairs (VA) Office of Connected Care widely expanded its video-enabled tablet program to bridge digital divides for veterans with limited video care access. OBJECTIVE This study aimed to characterize veterans who received and used US Department of VA-issued video-enabled tablets before versus during the COVID-19 pandemic. METHODS We compared sociodemographic and clinical characteristics of veterans who received VA-issued tablets during 6-month prepandemic and pandemic periods (ie, from March 11, 2019, to September 10, 2019, and from March 11, 2020, to September 10, 2020). Then, we examined characteristics associated with video visit use for primary and mental health care within 6 months after tablet shipment, stratifying models by timing of tablet receipt. RESULTS There was a nearly 6-fold increase in the number of veterans who received tablets in the pandemic versus prepandemic study periods (n=36,107 vs n=6784, respectively). Compared to the prepandemic period, tablet recipients during the pandemic were more likely to be older (mean age 64 vs 59 years), urban-dwelling (24,504/36,107, 67.9% vs 3766/6784, 55.5%), and have a history of housing instability (8633/36,107, 23.9% vs 1022/6784, 15.1%). Pandemic recipients were more likely to use video care (21,090/36,107, 58.4% vs 2995/6784, 44.2%) and did so more frequently (5.6 vs 2.3 average encounters) within 6 months of tablet receipt. In adjusted models, pandemic and prepandemic video care users were significantly more likely to be younger, stably housed, and have a mental health condition than nonusers. CONCLUSIONS Although the COVID-19 pandemic led to increased distribution of VA-issued tablets to veterans with complex clinical and social needs, tablet recipients who were older or unstably housed remained less likely to have a video visit. The VA's tablet distribution program expanded access to video-enabled devices, but interventions are needed to bridge disparities in video visit use among device recipients.
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Affiliation(s)
| | - Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
| | - James Van Campen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Cindie Slightam
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Josephine C Jacobs
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth Services, Veterans Health Administration, Washington, DC, United States.,Department of Medicine, University of California San Diego Health System, San Diego, CA, United States
| | - Donna Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
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21
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Garvin LA, Greenan MA, Edelman EJ, Slightam C, McInnes DK, Zulman DM. Increasing Use of Video Telehealth Among Veterans Experiencing Homelessness with Substance Use Disorder: Design of A Peer-Led Intervention. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 8:1-12. [PMID: 36573210 PMCID: PMC9769469 DOI: 10.1007/s41347-022-00290-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/24/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
Telehealth offers promising opportunities, but also challenges, for veterans experiencing homelessness - during the COVID-19 pandemic and beyond. Recent research found low utilization of clinical video visits among homeless veterans receiving a VA tablet, and having a substance use disorder (SUD) further reduced visit likelihood. Hence, this study sought to identify unique barriers to telehealth use among veterans experiencing homelessness with a SUD and design an intervention to promote adoption. This qualitative study was guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) model. The study's three phases included veteran interviews (N = 28) to identify barriers and facilitators to video telehealth use and propose intervention candidates, a provider expert panel to obtain feedback on interventions, and a focus group with veterans to complete the intervention. Finally, a prototype was designed using the intervention mapping approach. Veteran interviews revealed that barriers to video telehealth included complex physical and mental health issues, lack of digital literacy, and insufficient technical support. Together, veterans and experts proposed five intervention candidates. In the end, a veteran focus group combined two candidates, peer-led digital training and motivational interviewing. Intervention mapping was used to design a "stepped care" intervention that trains and activates veterans at all skill levels. This study demonstrates how inclusion of expert and veteran views led to development of a novel intervention to support and sustain video telehealth use among veterans experiencing homeless with SUD.
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Affiliation(s)
- Lynn A. Garvin
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA USA
| | - Mary Alexis Greenan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA USA
| | - E. Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT USA
| | - Cindie Slightam
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA USA
| | - D. Keith McInnes
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA USA
| | - Donna M. Zulman
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA USA
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22
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Griffin AC, Troszak LK, Van Campen J, Midboe AM, Zulman DM. Tablet distribution to veterans: an opportunity to increase patient portal adoption and use. J Am Med Inform Assoc 2022; 30:73-82. [PMID: 36269168 PMCID: PMC9748532 DOI: 10.1093/jamia/ocac195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/01/2022] [Accepted: 10/10/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Examine whether distribution of tablets to patients with access barriers influences their adoption and use of patient portals. MATERIALS AND METHODS This retrospective cohort study included Veterans Affairs (VA) patients (n = 28 659) who received a VA-issued tablet between November 1, 2020 and April 30, 2021. Tablets included an app for VA's My HealtheVet (MHV) portal. Veterans were grouped into 3 MHV baseline user types (non-users, inactive users, and active users) based on MHV registration status and feature use pre-tablet receipt. Three multivariable models were estimated to examine the factors predicting (1) MHV registration among non-users, (2) any MHV feature use among inactive users, and (3) more MHV use among active users post-tablet receipt. Differences in feature use during the 6 months pre-/post-tablet were examined with McNemar chi-squared tests of proportions. RESULTS In the 6 months post-tablet, 1298 (8%) non-users registered for MHV, 525 (24%) inactive users used at least one MHV feature, and 4234 (46%) active users increased feature use. Across veteran characteristics, there were differences in registration and feature use post-tablet, particularly among older adults and those without prior use of video visits (P < .01). Among active users, use of all features increased during the 6 months post-tablet, with the greatest differences in viewing prescription refills and scheduling appointments (P < .01). CONCLUSION Providing patients who experience barriers to in-person care with a portal-enabled device supports engagement in health information and management tasks. Additional strategies are needed to promote registration and digital inclusion among inactive and non-users of portals.
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Affiliation(s)
- Ashley C Griffin
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Lara K Troszak
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - James Van Campen
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Amanda M Midboe
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Donna M Zulman
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
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23
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Luna P, Lee M, Vergara Greeno R, DeLucia N, London Y, Hoffman P, Burg M, Harris K, Spatz ES, Mena-Hurtado C, Smolderen KG. Telehealth care before and during COVID-19: trends and quality in a large health system. JAMIA Open 2022; 5:ooac079. [PMID: 36204596 PMCID: PMC9531686 DOI: 10.1093/jamiaopen/ooac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/26/2022] [Accepted: 09/29/2022] [Indexed: 11/14/2022] Open
Abstract
Objective COVID-19 accelerated telehealth use to ensure care delivery, but there is limited data on the patient perspective. This study aimed to examine telehealth visit uptake before and during COVID-19 and correlates of patient satisfaction and interest in future telehealth visits. Materials and Methods This was a cross-sectional observational study between October 2019 and April 2020. Participants included patients who completed satisfaction surveys following telehealth visits. Results A total of 8930 patients completed the satisfaction survey using 4-point Likert Scales. Multivariable, hierarchical, cumulative logit models were constructed to examine correlates of satisfaction with quality of care and interest in future telehealth visits. Most patients were satisfied with the patient portal, video quality, and instructions (92.7%-96.8%). Almost half reported saving 1-2 h (46.9%). Correlates positively associated with quality of care and interest in future telehealth visits were ease of patient portal (odds ratio [OR], 1.43, 95% confidence interval [CI], 1.30-1.58; OR, 1.56, 95% CI, 1.41-1.73, respectively), video quality (OR, 1.62, 95% CI, 1.50-1.75; OR, 1.26, 95% CI, 1.16-1.37, respectively), instructions (OR, 5.62, 95% CI, 5.05-6.26; OR, 1.80, 95% CI, 1.62-2.01, respectively), and time saved (>4 h: OR, 1.69, 95%,CI, 1.22-2.34; OR, 3.49, 95% CI, 2.47-4.93, respectively). Being seen after the COVID-19 surge in telehealth (OR, 0.76, 95% CI, 0.63-0.93) or by providers with higher visit volume (OR, 0.71, 95% CI, 0.60-0.85) was associated with lower interest in future telehealth visits. Conclusions Patients expressed relatively high satisfaction levels with telehealth. Better technical quality, quality of instructions, and greater time saved were associated with higher satisfaction ratings. To maintain interest in future telehealth use and improve the patient experience, we must enhance the quality of telehealth delivery platforms and instructions provided to patients.
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Affiliation(s)
- Paulina Luna
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Megan Lee
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Pamela Hoffman
- Department of Child Psychiatry, Yale University, New Haven, Connecticut, USA
| | - Matthew Burg
- Department of Internal Medicine—Cardiology, Yale University, New Haven, Connecticut, USA
| | - Kristie Harris
- Department of Internal Medicine—Cardiology, Yale University, New Haven, Connecticut, USA
| | - Erica S Spatz
- Department of Internal Medicine—Cardiology, Yale University, New Haven, Connecticut, USA
| | - Carlos Mena-Hurtado
- Department of Internal Medicine—Cardiology, Yale University, New Haven, Connecticut, USA
| | - Kim G Smolderen
- Corresponding Author: Kim G. Smolderen, PhD, Department of Internal Medicine, Section of Cardiovascular Medicine, Vascular Medicine Outcomes Program (VAMOS), Yale University, 789 Howard Ave, New Haven, CT 06520, USA;
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24
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Tisdale RL, Ferguson J, Van Campen J, Greene L, Sandhu AT, Heidenreich PA, Zulman DM. Disparities in virtual cardiology visits among Veterans Health Administration patients during the COVID-19 pandemic. JAMIA Open 2022; 5:ooac103. [PMID: 36531138 PMCID: PMC9754629 DOI: 10.1093/jamiaopen/ooac103] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 10/06/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Objective In response to the coronavirus disease 2019 (COVID-19) pandemic, the Veterans Health Administration (VA) rapidly expanded virtual care (defined as care delivered by video and phone), raising concerns about technology access disparities (ie, the digital divide). Virtual care was somewhat established in primary care and mental health care prepandemic, but video telehealth implementation was new for most subspecialties, including cardiology. We sought to identify patient characteristics of virtual and video-based care users in VA cardiology clinics nationally during the first year of the COVID-19 pandemic. Materials and Methods Cohort study of Veteran patients across all VA facilities with a cardiology visit January 1, 2019-March 10, 2020, with follow-up January 1, 2019-March 10, 2021. Main measures included cardiology visits by visit type and likelihood of receiving cardiology-related virtual care, calculated with a repeated event survival model. Results 416 587 Veterans with 1 689 595 total cardiology visits were analyzed; average patient age was 69.6 years and 4.3% were female. Virtual cardiology care expanded dramatically early in the COVID-19 pandemic from 5% to 70% of encounters. Older, lower-income, and rural-dwelling Veterans and those experiencing homelessness were less likely to use video care (adjusted hazard ratio for ages 75 and older 0.80, 95% confidence interval (CI) 0.75-0.86; for highly rural residents 0.77, 95% CI 0.68-0.87; for low-income status 0.94, 95% CI 0.89-0.98; for homeless Veterans 0.85, 95% CI 0.80-0.92). Conclusion The pandemic worsened the digital divide for cardiology care for many vulnerable patients to the extent that video visits represent added value over phone visits. Targeted interventions may be necessary for equity in COVID-19-era access to virtual cardiology care.
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Affiliation(s)
- Rebecca L Tisdale
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Jacqueline Ferguson
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - James Van Campen
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Liberty Greene
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexander T Sandhu
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Donna M Zulman
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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25
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Lankila T, Laatikainen T, Wikström K, Linna M, Antikainen H. Association of travel time with mental health service use in primary health care according to contact type - a register-based study in Kainuu, Finland. BMC Health Serv Res 2022; 22:1458. [PMID: 36451184 PMCID: PMC9713086 DOI: 10.1186/s12913-022-08815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The study aim was to analyse how mental health services are used in different parts of the Kainuu region in Finland and whether travel time to primary health care services is associated with the use of different contact types (in-person visits, remote contacts, home visits). METHODS The study population included adults who had used mental health services under primary health care (N = 7643) between 2015 and 2019. The travel times to the nearest health centre in a municipality were estimated as the population-weighted average drive time in postal code areas. The Kruskal-Wallis test and pairwise comparisons with Dunn-Bonferroni post hoc tests were used to assess the differences in mental health service use between health centre areas. A negative binomial regression was performed for the travel time categories using different contact types of mental health service use as outcomes. Models were adjusted for gender, age, number of mental health diseases and the nearest health centre in the municipality. RESULTS Distance was negatively associated with mental health service use in health centre in-person visits and in home visits. In the adjusted models, there were 36% fewer in-person visits and 83% fewer home visits in distances further than 30 min, and 67% fewer home visits in a travel time distance of 15-30 min compared with 15 min travel time distance from a health centre. In the adjusted model, in remote contacts, the incidence rate ratios increased with distance, but the association was not statistically significant. CONCLUSIONS The present study revealed significant differences in mental health service use in relation to travel time and contact type, indicating possible problems in providing services to distant areas. Long travel times can pose a barrier, especially for home care and in-person visits. Remote contacts may partly compensate for the barrier effects of long travel times in mental health services. Especially with conditions that call for the continuation and regularity of care, enabling factors, such as travel time, may be important.
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Affiliation(s)
- Tiina Lankila
- grid.10858.340000 0001 0941 4873Geography Research Unit, University of Oulu, P.O Box 8000, 90014 Oulu, Finland
| | - Tiina Laatikainen
- grid.14758.3f0000 0001 1013 0499Department of Public Health and Social Welfare, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland ,grid.9668.10000 0001 0726 2490Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland ,Joint Municipal Authority for North Karelia Social and Health Services, (Siun Sote), Tikkamäentie 16, 80210 Joensuu, Finland
| | - Katja Wikström
- grid.14758.3f0000 0001 1013 0499Department of Public Health and Social Welfare, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland ,grid.9668.10000 0001 0726 2490Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - Miika Linna
- grid.9668.10000 0001 0726 2490Department of Health and Social Care Management, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland ,grid.5373.20000000108389418Institute of Healthcare Engineering, management and architecture, Aalto University, Espoo, Finland
| | - Harri Antikainen
- grid.10858.340000 0001 0941 4873Geography Research Unit, University of Oulu, P.O Box 8000, 90014 Oulu, Finland
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26
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Rahman Jabin MS, Hammar T. Issues with the Swedish e-prescribing system - An analysis of health information technology-related incident reports using an existing classification system. Digit Health 2022; 8:20552076221131139. [PMID: 36249479 PMCID: PMC9554230 DOI: 10.1177/20552076221131139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To identify issues with the Swedish e-prescribing system and devise a set of recommendations to overcome the identified challenges. Methods A number of health information technology-related incidents were collected retrospectively from various sources using purposive and snowball sampling. A search term containing five keywords was used to identify the electronic prescription-related incidents. The identified incidents (n = 24) were subjected to an existing framework, i.e., the Health Information Technology Classification System. Special attention was paid to the software-related issues, which were analysed using thematic analysis. Results Several types of software-related issues (n = 22) were identified: system configuration, interface with other software systems or components, software functionality, data storage and backup, record migration, software not accessible, and network/server down or slow. Both human and technical factors contributed to these incidents, including prescriptions not cancelled actively, drug handling errors, software programming errors, and system updates/upgrades. These software problems led to various consequences, such as incidents affecting multiple patients’ care management, delays in patient care, and risks of serious deterioration of health. Several temporary initiatives or administrative adjustments, for instance, cover letters to patients and local strategies, were used to overcome some of these challenges. Conclusions This study provides insights into the challenges related to the e-prescribing system, contributing factors, consequences, and actions taken to mitigate those risks. Therefore, healthcare organisations using the e-prescribing system should adopt the provided recommendations to minimise the risks of design and developmental challenges, implementation and use-related issues, and the problems related to monitoring, evaluation, and optimisation.
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Affiliation(s)
- Md Shafiqur Rahman Jabin
- Md Shafiqur Rahman Jabin, Department of Medicine and Optometry, eHealth Institute, Linnaeus University, Hus Vita (level 3), Kalmar 392 31, Sweden.
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27
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Sullivan SR, Myhre K, Mitchell EL, Monahan M, Khazanov G, Spears AP, Gromatsky M, Walsh S, Goodman A, Jager-Hyman S, Green KL, Brown GK, Stanley B, Goodman M. Suicide and Telehealth Treatments: A PRISMA Scoping Review. Arch Suicide Res 2022; 26:1794-1814. [PMID: 35137677 DOI: 10.1080/13811118.2022.2028207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND This PRISMA scoping review explored worldwide research on the delivery of suicide-specific interventions through an exclusive telehealth modality. Research over telehealth modalities with suicidal individuals highlights the importance of facilitating participants' access to treatments despite location and circumstances (e.g., rural, expenses related to appointments, etc.). AIM The review sought evidence of outcomes of trials or projects in which both the patient and therapist attended sessions conjointly and openly discussed suicide over a telehealth modality (e.g., phone, zoom). METHOD To explore this topic the authors searched for research trials and quality improvement projects using Ovid Medline, Ovid Embase, Ovid PsycINFO, EBSCO Social Services Abstracts, and Web of Science on 3/3/2021. RESULTS Nine different articles were included that each spanned distinct treatments, with eight being research studies and one being a quality improvement project. LIMITATIONS Publications featuring ongoing or upcoming research in which complete study results were not available did not meet inclusion criteria for this review. CONCLUSION Several important research gaps were identified. While this approach has been largely understudied, exclusive telehealth delivery of suicide-specific interventions has great potential for the prevention of suicidality, especially in the era of COVID-19 and beyond.
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28
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Kamath CC, Kelpin SS, Patten CA, Rummans TA, Kremers HM, Oesterle TS, Williams MD, Breitinger SA. Shaping the Screening, Behavioral Intervention, and Referral to Treatment (SBIRT) Model for Treatment of Alcohol Use Disorder in the COVID-19 Era. Mayo Clin Proc 2022; 97:1774-1779. [PMID: 36202491 PMCID: PMC9293785 DOI: 10.1016/j.mayocp.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/15/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Celia C Kamath
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| | - Sydney S Kelpin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery (H.M.K.), Mayo Clinic, Rochester, MN
| | - Tyler S Oesterle
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Mark D Williams
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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29
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Chen PV, Helm A, Caloudas SG, Ecker A, Day G, Hogan J, Lindsay J. Evidence of Phone vs Video-Conferencing for Mental Health Treatments: A Review of the Literature. Curr Psychiatry Rep 2022; 24:529-539. [PMID: 36053400 PMCID: PMC9437398 DOI: 10.1007/s11920-022-01359-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW The goal of this paper is to provide a comparative review of using phone (audio-only) or video for mental health treatments. Our review includes evidence of phone and video's effectiveness in terms of reduced symptomology, retention, satisfaction, therapeutic alliance, and other outcomes of interest. This review also discusses how patients and providers' experiences and attitudes differ between these two modalities. Finally, we present information on different usage rates of phone and video across patient populations and mental health provider types, and different implementation strategies. RECENT FINDINGS Treatments through phone and video are both able to reduce symptoms related to mental health conditions and have both been found to be non-inferior to in-person care. Both phone and video are more convenient to patients. Video offers important visual information that can be important to diagnosing mental health conditions. Phone, however, is more broadly accessible and may come with fewer technological issues. In the context of mental health care, where non-verbal cues are tied to symptomology and diagnosing, and a strong relationship between patient and provider can enhance treatment, we encourage the use of video, especially for psychotherapeutic services. However, as phone is more accessible, we ultimately recommend an accommodating approach, one that flexibly makes use of both phone and video. Future studies on telehealth should focus on direct, head-to-head comparisons between phone and video and conduct more rigorous testing on whether clinical differences exist.
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Affiliation(s)
- Patricia V Chen
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
- Margaret M. and Albert B Alkek Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Ashley Helm
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
| | - Steve G Caloudas
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Anthony Ecker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
| | - Giselle Day
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
| | - Julianna Hogan
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
| | - Jan Lindsay
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
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Thomas B, Thadani A, Chen PV, Christie IC, Kern LM, Rajan M, Kadiyala H, Helmer DA. Veterans’ ambulatory care experience during COVID-19: veterans’ access to and satisfaction with primary care early in the pandemic. BMC PRIMARY CARE 2022; 23:245. [PMID: 36131246 PMCID: PMC9491256 DOI: 10.1186/s12875-022-01851-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 09/11/2022] [Indexed: 11/10/2022]
Abstract
Background The COVID-19 pandemic caused widespread changes to healthcare, but few studies focus on ambulatory care during the early phase of the pandemic. We characterize veterans’ ambulatory care experience, specifically access and satisfaction, early in the pandemic. Methods We employed a semi-structured telephone interview to capture quantitative and qualitative data from patients scheduled with a primary care provider between March 1 – June 30, 2020. Forty veterans were randomly identified at a single large urban Veterans Health Administration (VHA) medical center. The interview guide utilized 56 closed and open-ended questions to characterize veterans’ perceptions of access to and satisfaction with their primary care experience at VHA and non-VHA primary care sources. We also explored the context of veterans' daily lives during the pandemic. We analyzed quantitative data using descriptive statistics and verbatim quotes using a matrix analysis. Results Veterans reported completing more appointments (mean 2.6 (SD 2.2)) than scheduled (mean 2.3 (SD 2.2)) mostly due to same-day or urgent visits, with a shift to telephone (mean 2.1 (SD 2.2)) and video (mean 1.5 (SD 0.6)). Among those who reported decreased access to care early in the pandemic (n = 27 (67%)), 15 (56%) cited administrative barriers (“The phone would hang up on me”) and 9 (33%) reported a lack of provider availability (“They are not reaching out like they used to”). While most veterans (n = 31 (78%)) were highly satisfied with their VHA care (mean score 8.6 (SD 2.0 on a 0–10 scale), 9 (23%) reported a decrease in satisfaction since the pandemic. The six (15%) veterans who utilized non-VHA providers during the period of interest reported, on average, higher satisfaction ratings (mean 9.5 (SD 1.2)). Many veterans reported psychosocial effects such as the worsening of mental health (n = 6 (15%)), anxiety concerning the virus (n = 12 (30%)), and social isolation (n = 8 (20%), “I stay inside and away from people”). Conclusions While the number of encounters reported suggest adequate access and satisfaction, the comments regarding barriers to care suggest that enhanced approaches may be warranted to improve and sustain veteran perceptions of adequate access to and satisfaction with primary care during times of crisis. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01851-3.
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Vakkalanka JP, Lund BC, Ward MM, Arndt S, Field RW, Charlton M, Carnahan RM. Telehealth Utilization Is Associated with Lower Risk of Discontinuation of Buprenorphine: a Retrospective Cohort Study of US Veterans. J Gen Intern Med 2022; 37:1610-1618. [PMID: 34159547 PMCID: PMC8219175 DOI: 10.1007/s11606-021-06969-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Treatment for opioid use disorder (OUD) may include a combination of pharmacotherapies (such as buprenorphine) with counseling services if clinically indicated. Medication management or engagement with in-person counseling services may be hindered by logistical and financial barriers. Telehealth may provide an alternative mechanism for continued engagement. This study aimed to evaluate the association between telehealth encounters and time to discontinuation of buprenorphine treatment when compared to traditional in-person visits and to evaluate potential effect modification by rural-urban designation and in-person and telehealth combination treatment. METHODS A retrospective cohort study of Veterans diagnosed with OUD and treated with buprenorphine across all facilities within the Veterans Health Administration (VHA) between 2008 and 2017. Exposures were telehealth and in-person encounters for substance use disorder (SUD) and mental health, treated as time-varying covariates. The primary outcome was treatment discontinuation, evaluated as 14 days of absence of medication from initiation through 1 year. RESULTS Compared to in-person encounters, treatment discontinuation was lower for telehealth for SUD (aHR: 0.69; 95%CI: 0.60, 0.78) and mental health (aHR: 0.69; 95%CI: 0.62, 0.76). There was no evidence of effect modification by rural-urban designation. Risk of treatment discontinuation appeared to be lower among those with telehealth only compared to in-person only for both SUD (aHR: 0.48, 95%CI: 0.37, 0.62) and for mental health (aHR: 0.46; 95%CI: 0.33, 0.65). CONCLUSIONS As telehealth demonstrated improved treatment retention compared to in-person visits, it may be a suitable option for engagement for patients in OUD management. Efforts to expand services may improve treatment retention and health outcomes for VHA and other health care systems.
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Affiliation(s)
- J Priyanka Vakkalanka
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA. .,Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Brian C Lund
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.,Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Marcia M Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Stephan Arndt
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA.,Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - R William Field
- Department of Occupational and Environmental Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Mary Charlton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Ryan M Carnahan
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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32
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Baird A, Xia Y, Cheng Y. Consumer perceptions of telehealth for mental health or substance abuse: a Twitter-based topic modeling analysis. JAMIA Open 2022; 5:ooac028. [PMID: 35495736 PMCID: PMC9047171 DOI: 10.1093/jamiaopen/ooac028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/18/2022] [Accepted: 04/14/2022] [Indexed: 12/26/2022] Open
Abstract
Objective The objective of this study is to understand the primary topics of consumer discussion on Twitter associated with telehealth for mental health or substance abuse for prepandemic versus during-pandemic time-periods, using a state-of-the-art machine learning (ML) natural language processing (NLP) method. Materials and Methods The primary methodological phases of this project were: (1) collecting, cleaning, and filtering data (tweets) from January 2014 to June 2021, (2) describing the final corpus, (3) running and optimizing Bidirectional Encoder Representations from Transformers (BERT; using BERTopic in Python) models, and (4) human refinement of topic model results and thematic classification of topics. Results The number of tweets in this context increased by 4 times during the pandemic (2017 tweets prepandemic vs 8672 tweets during the pandemic). During the pandemic topics were more frequently mental health related than substance abuse related. Top during-pandemic topics were therapy, suicide, pain (associated with burnout and drinking), and mental health diagnoses such as ADHD and autism. Anxiety was a key topic of discussion both pre- and during the pandemic. Discussion Telehealth for mental health and substance abuse is being discussed more frequently online, which implies growing demand. Given the topics extracted as proxies for demand, the most demand is currently for telehealth for mental health primarily, especially for children, parents, and therapy for those with anxiety or depression, and substance abuse secondarily. Conclusions Scarce telehealth resources can be allocated more efficiently if topics of consumer discussion are included in resource allocation decision- and policy-making processes. Telehealth for mental health and substance abuse is being discussed more frequently online. To determine what aspects of telehealth for mental health and/or substance abuse were being discussed most on Twitter, both before the pandemic and during the pandemic, we downloaded relevant tweets and ran a specialized machine learning model that extracts the most popular keywords from tweets as well as combines similar keywords into overall topics. We find 33 relevant topics prepandemic and 32 relevant topics during the pandemic to be relevant in this context. Given the topics extracted as proxies for demand, the most demand is currently for telehealth for mental health primarily, especially for children, parents, and therapy for those with anxiety or depression, and substance abuse secondarily. We also find that therapy and therapists were the top areas of discussion in regard to telehealth for mental health and/or substance abuse during the pandemic. These results can be applied to telehealth decision-making processes. In particular, scarce telehealth resources can be allocated more efficiently, particularly to those who currently need or want them most, if topics of consumer discussion are included in resource allocation decision- and policy-making processes.
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Affiliation(s)
- Aaron Baird
- Institute of Health Administration, Georgia State University, Atlanta, Georgia, USA
- Department of Computer Information Systems, Robinson College of Business, Georgia State University, Atlanta, Georgia, USA
| | - Yusen Xia
- Institute for Insight, Robinson College of Business, Georgia State University, Atlanta, Georgia, USA
| | - Yichen Cheng
- Institute for Insight, Robinson College of Business, Georgia State University, Atlanta, Georgia, USA
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33
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Gujral K, Van Campen J, Jacobs J, Kimerling R, Blonigen D, Zulman DM. Mental Health Service Use, Suicide Behavior, and Emergency Department Visits Among Rural US Veterans Who Received Video-Enabled Tablets During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e226250. [PMID: 35385088 PMCID: PMC8987904 DOI: 10.1001/jamanetworkopen.2022.6250] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Suicide rates are rising disproportionately in rural counties, a concerning pattern as the COVID-19 pandemic has intensified suicide risk factors in these regions and exacerbated barriers to mental health care access. Although telehealth has the potential to improve access to mental health care, telehealth's effectiveness for suicide-related outcomes remains relatively unknown. OBJECTIVE To evaluate the association between the escalated distribution of the US Department of Veterans Affairs' (VA's) video-enabled tablets during the COVID-19 pandemic and rural veterans' mental health service use and suicide-related outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included rural veterans who had at least 1 VA mental health care visit in calendar year 2019 and a subcohort of patients identified by the VA as high-risk for suicide. Event studies and difference-in-differences estimation were used to compare monthly mental health service utilization for patients who received VA tablets during COVID-19 with patients who were not issued tablets over 10 months before and after tablet shipment. Statistical analysis was performed from November 2021 to February 2022. EXPOSURE Receipt of a video-enabled tablet. MAIN OUTCOMES AND MEASURES Mental health service utilization outcomes included psychotherapy visits, medication management visits, and comprehensive suicide risk evaluations (CSREs) via video and total visits across all modalities (phone, video, and in-person). We also analyzed likelihood of emergency department (ED) visit, likelihood of suicide-related ED visit, and number of VA's suicide behavior and overdose reports (SBORs). RESULTS The study cohort included 13 180 rural tablet recipients (11 617 [88%] men; 2161 [16%] Black; 301 [2%] Hispanic; 10 644 [80%] White; mean [SD] age, 61.2 [13.4] years) and 458 611 nonrecipients (406 545 [89%] men; 59 875 [13%] Black or African American; 16 778 [4%] Hispanic; 384 630 [83%] White; mean [SD] age, 58.0 [15.8] years). Tablets were associated with increases of 1.8 psychotherapy visits per year (monthly coefficient, 0.15; 95% CI, 0.13-0.17), 3.5 video psychotherapy visits per year (monthly coefficient, 0.29; 95% CI, 0.27-0.31), 0.7 video medication management visits per year (monthly coefficient, 0.06; 95% CI, 0.055-0.062), and 0.02 video CSREs per year (monthly coefficient, 0.002; 95% CI, 0.002-0.002). Tablets were associated with an overall 20% reduction in the likelihood of an ED visit (proportion change, -0.012; 95% CI, -0.014 to -0.010), a 36% reduction in the likelihood of suicide-related ED visit (proportion change, -0.0017; 95% CI, -0.0023 to -0.0013), and a 22% reduction in the likelihood of suicide behavior as indicated by SBORs (monthly coefficient, -0.0011; 95% CI, -0.0016 to -0.0005). These associations persisted for the subcohort of rural veterans the VA identifies as high-risk for suicide. CONCLUSIONS AND RELEVANCE This cohort study of rural US veterans with a history of mental health care use found that receipt of a video-enabled tablet was associated with increased use of mental health care via video, increased psychotherapy visits (across all modalities), and reduced suicide behavior and ED visits. These findings suggest that the VA and other health systems should consider leveraging video-enabled tablets for improving access to mental health care via telehealth and for preventing suicides among rural residents.
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Affiliation(s)
- Kritee Gujral
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California
| | - James Van Campen
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Josephine Jacobs
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California
| | - Rachel Kimerling
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California
- National Center for Post-Traumatic Stress Disorder, VA Palo Alto Health Care System, Menlo Park, California
| | - Dan Blonigen
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California
| | - Donna M. Zulman
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Evaluation of the Use of Telehealth Video Visits for Veterans With Chronic Pain. Pain Manag Nurs 2022; 23:418-423. [PMID: 35331651 PMCID: PMC8934702 DOI: 10.1016/j.pmn.2022.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/29/2021] [Accepted: 02/06/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Telehealth video visits are essential for delivering timely care while mitigating exposure during the COVID-19 pandemic. Telehealth video visits have the potential to improve missed appointments, reduce costs associated with Veterans Affairs (VA) travel reimbursement, and lead to positive patient and provider satisfaction. AIMS This evidence-based improvement project sought to evaluate whether telehealth visits reduce the occurrence of missed appointments, determine cost savings associated with the VA travel reimbursement and assess patient and provider satisfaction with telehealth video visits. DESIGN Evidence-based improvement project. SETTING A retrospective chart review was conducted on military veterans with chronic pain who completed a telehealth video visit in the VA San Diego (VASD) pain clinic. METHODS Missed appointment rates were compared from before (April 1, 2019-October 1, 2019) to after (April 1, 2020-October 1, 2020) implementation of the telehealth video visits. Estimated travel reimbursement for qualified patients was calculated per VA policy. Electronic satisfaction surveys were administered to patients and nurse practitioners to assess satisfaction with telehealth video visits. RESULTS There was an 82.5% reduction in missed appointments from pre to post implementation of telehealth video visits. There was an estimated cost savings in travel reimbursements of $3,308.30. Overall, 93.62% of patients (n = 42) were satisfied with their video visits and there was a high degree of satisfaction in implementing video visits among the nurse practitioners (n = 3). CONCLUSIONS The use of telehealth video visits during the COVID-19 pandemic reduced missed appointments, exhibited cost savings in VA travel reimbursement, and led to positive patient and provider satisfaction.
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35
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Fessler EB, Brown RT, Miller RK. Rebooting Instrumental Activities of Daily Living for the 21st Century. Ann Intern Med 2022; 175:278-279. [PMID: 34928697 DOI: 10.7326/m21-3065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Emily B Fessler
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York (E.B.F.)
| | - Rebecca T Brown
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, and Center for Health Equity Research and Promotion and Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania (R.T.B.)
| | - Rachel K Miller
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, and Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania (R.K.M.)
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36
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Wray C, Tang J, Byers A, Keyhani S. Digital Health Skillsets and Digital Preparedness: Comparison of Veterans Health Administration Users and Other Veterans Nationally. JMIR Form Res 2022; 6:e32764. [PMID: 35089147 PMCID: PMC8838565 DOI: 10.2196/32764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/03/2021] [Accepted: 12/13/2021] [Indexed: 02/06/2023] Open
Abstract
Background As health care systems shift to greater use of telemedicine and digital tools, an individual’s digital health literacy has become an important skillset. The Veterans Health Administration (VA) has invested resources in providing digital health care; however, to date, no study has compared the digital health skills and preparedness of veterans receiving care in the VA to veterans receiving care outside the VA. Objective The goal of the research was to describe digital health skills and preparedness among veterans who receive care within and outside the VA health care system and examine whether receiving care in the VA is associated with digital preparedness (reporting more than 2 digital health skills) after accounting for demographic and social risk factors. Methods We used cross-sectional data from the 2016-2018 National Health Interview Survey to identify veterans (aged over 18 years) who obtain health care either within or outside the VA health care system. We used multivariable logistic regression models to examine the association of sociodemographic (age, sex, race, ethnicity), social risk factors (economic instability, disadvantaged neighborhood, low educational attainment, and social isolation), and health care delivery location (VA and non-VA) with digital preparedness. Results Those who received health care within the VA health care system (n=3188) were younger (age 18-49 years: 33.3% [95% CI 30.7-36.0] vs 24.2% [95% CI 21.9-26.5], P<.01), were more often female (34.7% [95% CI 32.0-37.3] vs 6.6% [95% CI 5.5-7.6], P<.01) and identified as Black (13.1% [95% CI 11.2-15.0] vs 10.2% [95% CI 8.7-11.8], P<.01), and reported greater economic instability (8.3% [95% CI 6.9-9.8] vs 5.5% [95% CI 4.6-6.5], P<.01) and social isolation (42.6% [95% CI 40.3-44.9] vs 35.4% [95% CI 33.4-37.5], P<.01) compared to veterans who received care outside the VA (n=3393). Veterans who obtained care within the VA reported more digital health skills than those who obtained care outside the VA, endorsing greater rates of looking up health information on the internet (51.8% [95% CI 49.2-54.4] vs 45.0% [95% CI 42.6-47.3], P<.01), filling a prescription using the internet (16.2% [95% CI 14.5-18.0] vs 11.3% [95% CI 9.6-13.0], P<.01), scheduling a health care appointment on the internet (14.1% [95% CI 12.4-15.8] vs 11.6% [95% CI 10.1-13.1], P=.02), and communicating with a health care provider by email (18.0% [95% CI 16.1-19.8] vs 13.3% [95% CI 11.6-14.9], P<.01). Following adjustment for sociodemographic and social risk factors, receiving health care from the VA was the only characteristic associated with higher odds (adjusted odds ratio [aOR] 1.36, 95% CI 1.12-1.65) of being digitally prepared. Conclusions Despite these demographic disadvantages to digital uptake, veterans who receive care in the VA reported more digital health skills and appear more digitally prepared than veterans who do not receive care within the VA, suggesting a positive, system-level influence on this cohort.
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Affiliation(s)
- Charlie Wray
- Section of Hospital Medicine, San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Janet Tang
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Amy Byers
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Division of Mental Health Services, San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Salomeh Keyhani
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Newell S, Denneson L, Rynerson A, Rabin S, Elliott V, Bahraini N, Post EP, Dobscha SK. Veterans Health Administration staff experiences with suicidal ideation screening and risk assessment in the context of COVID-19. PLoS One 2021; 16:e0261921. [PMID: 34962961 PMCID: PMC8714081 DOI: 10.1371/journal.pone.0261921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/13/2021] [Indexed: 11/19/2022] Open
Abstract
Universal screening for suicidal ideation in primary care and mental health settings has become a key prevention tool in many healthcare systems, including the Veterans Healthcare Administration (VHA). In response to the coronavirus pandemic, healthcare providers faced a number of challenges, including how to quickly adapt screening practices. The objective of this analyses was to learn staff perspectives on how the pandemic impacted suicide risk screening in primary care and mental health settings. Forty semi-structured interviews were conducted with primary care and mental health staff between April-September 2020 across 12 VHA facilities. A multi-disciplinary team employed a qualitative thematic analysis using a hybrid inductive/deductive approach. Staff reported multiple concerns for patients during the crisis, especially regarding vulnerable populations at risk for social isolation. Lack of clear protocols at some sites on how to serve patients screening positive for suicidal ideation created confusion for staff and led some sites to temporarily stop screening. Sites had varying degrees of adaptability to virtual based care, with the biggest challenge being completion of warm hand-offs to mental health specialists. Unanticipated opportunities that emerged during this time included increased ability of patients and staff to conduct virtual care, which is expected to continue benefit post-pandemic.
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Affiliation(s)
- Summer Newell
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States of America
| | - Lauren Denneson
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States of America
- Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, United States of America
| | - Annabelle Rynerson
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States of America
| | - Sarah Rabin
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States of America
| | - Victoria Elliott
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States of America
| | - Nazanin Bahraini
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, Colorado, United States of America
- University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Edward P. Post
- VA Ann Arbor, Center for Clinical Management Research, Ann Arbor, MI, United States of America
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Steven K. Dobscha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States of America
- Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, United States of America
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38
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Vakkalanka JP, Lund BC, Arndt S, Field W, Charlton M, Ward MM, Carnahan RM. Therapeutic relationships between Veterans and buprenorphine providers and effects on treatment retention. Health Serv Res 2021; 57:392-402. [PMID: 34854083 DOI: 10.1111/1475-6773.13919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/27/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To examine the extent to which there was any therapeutic relationship between Veterans and their initial buprenorphine provider and whether the presence of this relationship influenced treatment retention. DATA SOURCES National, secondary administrative data used from the Veterans Health Administration (VHA), 2008-2017. STUDY DESIGN Retrospective cohort study. The primary exposure was a therapeutic relationship between the Veteran and buprenorphine provider, defined as the presence of a previous visit or medication prescribed by the provider in the 2 years preceding buprenorphine treatment initiation. The primary outcome was treatment discontinuation, evaluated as 14 days of absence of medication from initiation through 1 year. DATA COLLECTION/EXTRACTION METHODS Adult Veterans (age ≥ 18 years) diagnosed with opioid use disorder and treated with buprenorphine or buprenorphine/naloxone within the VHA system were included in this study. We excluded those receiving buprenorphine patches, those with documentation of a metastatic tumor diagnosis within 2 years prior to buprenorphine initiation, and those without geographical information on rurality. PRINCIPAL FINDINGS A total of 28,791 Veterans were included in the study. Within the overall study sample, 56.3% (n = 16,206) of Veterans previously had at least one outpatient encounter with their initial buprenorphine provider, and 24.9% (n = 7174) of Veterans previously had at least one prescription from that provider in the 2 years preceding buprenorphine initiation. There was no significant or clinically meaningful association between therapeutic relationship history and treatment retention when defined as visit history (aHR: 0.99; 95% CI: 0.96, 1.02) or medication history (aHR: 1.03; 95% CI: 1.00, 1.07). CONCLUSIONS Veterans initiating buprenorphine frequently did not have a therapeutic history with their initial buprenorphine provider, but this relationship was not associated with treatment retention. Future work should investigate how the quality of Veteran-provider therapeutic relationships influences opioid use dependence management and whether eliminating training requirements for providers might affect access to buprenorphine, and subsequently, treatment initiation and retention.
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Affiliation(s)
- Jayamalathi Priyanka Vakkalanka
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.,Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Brian C Lund
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.,Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - Stephan Arndt
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA.,Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - William Field
- Department of Occupational and Environmental Health, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Mary Charlton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Marcia M Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Ryan M Carnahan
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
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39
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Hayden EM, Davis C, Clark S, Joshi AU, Krupinski EA, Naik N, Ward MJ, Zachrison KS, Olsen E, Chang BP, Burner E, Yadav K, Greenwald PW, Chandra S. Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine. Acad Emerg Med 2021; 28:1452-1474. [PMID: 34245649 PMCID: PMC11150898 DOI: 10.1111/acem.14330] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Telehealth has the potential to significantly change the specialty of emergency medicine (EM) and has rapidly expanded in EM during the COVID pandemic; however, it is unclear how EM should intersect with telehealth. The field lacks a unified research agenda with priorities for scientific questions on telehealth in EM. METHODS Through the 2020 Society for Academic Emergency Medicine's annual consensus conference, experts in EM and telehealth created a research agenda for the topic. The multiyear process used a modified Delphi technique to develop research questions related to telehealth in EM. Research questions were excluded from the final research agenda if they did not meet a threshold of at least 80% of votes indicating "important" or "very important." RESULTS Round 1 of voting included 94 research questions, expanded to 103 questions in round 2 and refined to 36 questions for the final vote. Consensus occurred with a final set of 24 important research questions spanning five breakout group topics. Each breakout group domain was represented in the final set of questions. Examples of the questions include: "Among underserved populations, what are mechanisms by which disparities in emergency care delivery may be exacerbated or ameliorated by telehealth" (health care access) and "In what situations should the quality and safety of telehealth be compared to in-person care and in what situations should it be compared to no care" (quality and safety). CONCLUSION The primary finding from the process was the breadth of gaps in the evidence for telehealth in EM and telehealth in general. Our consensus process identified priority research questions for the use of and evaluation of telehealth in EM to fill the current knowledge gaps. Support should be provided to answer the research questions to guide the evidenced-based development of telehealth in EM.
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Affiliation(s)
- Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Aditi U Joshi
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Neel Naik
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Erica Olsen
- Department of Emergency Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Kabir Yadav
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peter W Greenwald
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Shruti Chandra
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Jones AL, Gelberg L, deRussy AJ, Varley AL, Riggs KR, Gordon AJ, Kertesz SG. Low Uptake of Secure Messaging Among Veterans With Experiences of Homelessness and Substance Use Disorders. J Addict Med 2021; 15:508-511. [PMID: 33323688 PMCID: PMC8200366 DOI: 10.1097/adm.0000000000000785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Persons who are homeless have significant health challenges and barriers accessing care. Secure messaging supports communication between patients and their providers through a web-based portal, but the acceptability of this technology among patients with high prevalence of substance use disorders (SUDs) is unknown. We examined secure messaging use among veterans with experiences of homelessness (VEHs), and determined factors associated with messaging use. METHODS We conducted a cross-sectional analysis of responses to a national survey of VEHs, administered by mail from March to October 2018 (response rate = 40.2%). One item assessed secure messaging use and satisfaction. We used multivariable logistic regressions to model secure messaging use, controlling for sociodemographics, medical conditions, housing indicators, and mental health and SUD diagnoses. RESULTS Of 5072 VEHs, 21% had ever used secure messaging and 87% of the subsample found messaging to be useful. Secure messaging was more commonly used by VEHs who were female, had some college education, those with ≥3 chronic medical conditions, depression, or posttraumatic stress disorder (all P < 0.001). Messaging was much less common for VEHs ages 55 to 64 or older, non-Latino Blacks, those receiving homeless-tailored primary care, and those with SUDs (all P < 0.001). VEHs with opioid use disorder were even less likely than those with other SUDs to use secure messaging (P = 0.047). CONCLUSIONS Persons with homeless experiences might require assistance to engage with secure messaging technology. As health systems limit in-person care during a national pandemic, alternative solutions may be needed to facilitate health communications and prevent care disruptions for patients experiencing homelessness and SUDs.
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Affiliation(s)
- Audrey L. Jones
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Lillian Gelberg
- VA Greater Los Angeles Health Care System, Los Angeles, CA
- David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | | | - Allyson L. Varley
- Birmingham VA Medical Center, Birmingham, AL
- University of Birmingham at Alabama School of Medicine, Birmingham, AL
| | - Kevin R. Riggs
- Birmingham VA Medical Center, Birmingham, AL
- University of Birmingham at Alabama School of Medicine, Birmingham, AL
| | - Adam J. Gordon
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Stefan G. Kertesz
- Birmingham VA Medical Center, Birmingham, AL
- University of Birmingham at Alabama School of Medicine, Birmingham, AL
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Riblet NB, Stevens SP, Shiner B, Cornelius S, Forehand J, Scott RC, Watts BV. Longitudinal Examination of COVID-19 Public Health Measures on Mental Health for Rural Patients With Serious Mental Illness. Mil Med 2021; 186:e956-e961. [PMID: 33377975 PMCID: PMC7798823 DOI: 10.1093/milmed/usaa559] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/25/2020] [Accepted: 12/10/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction There is emerging evidence to support that the COVID-19 pandemic and related public health measures may be associated with negative mental health sequelae. Rural populations in particular may fair worse because they share many unique characteristics that may put them at higher risk for adverse outcomes with the pandemic. Yet, rural populations may also be more resilient due to increased sense of community. Little is known about the impact of the pandemic on the mental health and well-being of a rural population pre- and post-pandemic, especially those with serious mental illness. Material and Methods We conducted a longitudinal, mixed-methods study with assessments preceding the pandemic (between October 2019 and March 2020) and during the stay-at-home orders (between April 23, 2020, and May 4, 2020). Changes in hopelessness, suicidal ideation, connectedness, and treatment engagement were assessed using a repeated-measures ANOVA or Friedman test. Results Among 17 eligible participants, 11 people were interviewed. Overall, there were no notable changes in any symptom scale in the first 3-5 months before the pandemic or during the stay-at-home orders. The few patients who reported worse symptoms were significantly older (mean age: 71.7 years, SD: 4.0). Most patients denied disruptions to treatment, and some perceived telepsychiatry as beneficial. Conclusions Rural patients with serious mental illness may be fairly resilient in the face of the COVID-19 pandemic when they have access to treatment and supports. Longer-term outcomes are needed in rural patients with serious mental illness to better understand the impact of the pandemic on this population.
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Affiliation(s)
- Natalie B Riblet
- White River Junction Veterans Affairs Medical Center, White River Junction, VT 05009, USA.,Department of Psychiatry and Dartmouth Institute, Geisel School of Medicine at Dartmouth College, Hanover, NH 03755, USA
| | - Susan P Stevens
- White River Junction Veterans Affairs Medical Center, White River Junction, VT 05009, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Hanover, NH 03755, USA
| | - Brian Shiner
- White River Junction Veterans Affairs Medical Center, White River Junction, VT 05009, USA.,Department of Psychiatry and Dartmouth Institute, Geisel School of Medicine at Dartmouth College, Hanover, NH 03755, USA.,Mental Health National Center for PTSD, White River Junction, VT 05009, USA
| | - Sarah Cornelius
- White River Junction Veterans Affairs Medical Center, White River Junction, VT 05009, USA
| | - Jenna Forehand
- White River Junction Veterans Affairs Medical Center, White River Junction, VT 05009, USA
| | - Robert C Scott
- White River Junction Veterans Affairs Medical Center, White River Junction, VT 05009, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Hanover, NH 03755, USA
| | - Bradley V Watts
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Hanover, NH 03755, USA.,Systems Redesign and Improvement, VA Office of Systems Redesign and Improvement, White River Junction, VT 05009, USA
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Vakkalanka P, Lund BC, Arndt S, Field W, Charlton M, Ward MM, Carnahan RM. Association Between Buprenorphine for Opioid Use Disorder and Mortality Risk. Am J Prev Med 2021; 61:418-427. [PMID: 34023160 PMCID: PMC8384722 DOI: 10.1016/j.amepre.2021.02.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Veterans with opioid use disorder have an increased risk of suicide and overdose compared with the general population. Buprenorphine, a U.S. Food and Drug Administration-approved medication to treat opioid use disorder, has shown benefits, including decreased risk of illicit drug use and overdose. This study assesses the mortality outcomes with buprenorphine pharmacotherapy among Veterans up to 5 years from treatment initiation. METHODS This was a retrospective cohort study of Veterans receiving buprenorphine (2008-2017) across any Veterans Health Administration facility. Buprenorphine pharmacotherapy was evaluated as a time-varying covariate. The primary outcome was death up to 5 years from treatment initiation by suicide and overdose combined; secondary outcomes included suicide, overdose, opioid-specific overdose, and all-cause death. Secondary analyses included evaluating the risk of mortality in recent discontinuation and effect modification by select characteristics. All analyses were conducted in 2020. RESULTS Veterans who were not receiving buprenorphine were 4.33 (adjusted hazard ratio; 95% CI=3.60, 5.21) times more likely to die by suicide/overdose than those receiving buprenorphine pharmacotherapy on any given day, with similar protective associations with treatment across secondary outcomes. The risk of suicide/overdose was highest 8-14 days from treatment discontinuation (adjusted hazard ratio=6.54, 95% CI=4.32, 9.91) than in currently receiving buprenorphine pharmacotherapy. There was no evidence of effect modification by the selected covariates. CONCLUSIONS Mortality risk was greater among Veterans who were not receiving buprenorphine pharmacotherapy than among those who were. Providers should consider whether buprenorphine pharmacotherapy, either intermittent or continuous, may provide health benefits for their patients and prevent mortality.
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Affiliation(s)
- Priyanka Vakkalanka
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa; Department of Emergency Medicine, University of Iowa Carver College of Medicine, University of Iowa Health Care, Iowa City, Iowa.
| | - Brian C Lund
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa; Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
| | - Stephan Arndt
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa; Department of Psychiatry, University of Iowa Carver College of Medicine, University of Iowa Health Care, Iowa City, Iowa
| | - William Field
- Department of Occupational and Environmental Health, University of Iowa College of Public Health, Iowa City, Iowa
| | - Mary Charlton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | - Marcia M Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa
| | - Ryan M Carnahan
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
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Apaydin EA, Rose DE, McClean MR, Yano EM, Shekelle PG, Nelson KM, Stockdale SE. Association between care coordination tasks with non-VA community care and VA PCP burnout: an analysis of a national, cross-sectional survey. BMC Health Serv Res 2021; 21:809. [PMID: 34384398 PMCID: PMC8361617 DOI: 10.1186/s12913-021-06769-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The scope of care coordination in VA primary care increased with the launch of the Veterans Choice Act, which aimed to increase access through greater use of non-VA Community Care. These changes may have overburdened already busy providers with additional administrative tasks, contributing to provider burnout. Our objective was to understand the role of challenges with care coordination in burnout. We analyzed relationships between care coordination challenges with Community Care reported by VA primary care providers (PCPs) and VA PCP burnout. METHODS Our cross-sectional survey contained five questions about challenges with care coordination. We assessed whether care coordination challenges were associated with two measures of provider burnout, adjusted for provider and facility characteristics. Models were also adjusted for survey nonresponse and clustered by facility. Trainee and executive respondents were excluded. 1,543 PCPs in 129 VA facilities nationwide responded to our survey (13 % response rate). RESULTS 51 % of our sample reported some level of burnout overall, and 46 % reported feeling burned out at least once a week. PCPs were more likely to be burned out overall if they reported more than average challenges with care coordination (odds ratio [OR] 2.04, 95 % confidence interval [CI] 1.58 to 2.63). These challenges include managing patients with outside prescriptions or obtaining outside tests or records. CONCLUSIONS VA primary care providers who reported greater than average care coordination challenges were more likely to be burned out. Interventions to improve care coordination could help improve VA provider experience.
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Affiliation(s)
- Eric A Apaydin
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., MC 152, Bldg. 206 Rm. 252, Los Angeles, CA, 90073, USA.
- RAND Corporation, Santa Monica, CA, USA.
| | - Danielle E Rose
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., MC 152, Bldg. 206 Rm. 252, Los Angeles, CA, 90073, USA
| | - Michael R McClean
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., MC 152, Bldg. 206 Rm. 252, Los Angeles, CA, 90073, USA
| | - Elizabeth M Yano
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., MC 152, Bldg. 206 Rm. 252, Los Angeles, CA, 90073, USA
- Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Paul G Shekelle
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., MC 152, Bldg. 206 Rm. 252, Los Angeles, CA, 90073, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Karin M Nelson
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Susan E Stockdale
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., MC 152, Bldg. 206 Rm. 252, Los Angeles, CA, 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Bellanti DM, Kelber MS, Workman DE, Beech EH, Belsher BE. Rapid Review on the Effectiveness of Telehealth Interventions for the Treatment of Behavioral Health Disorders. Mil Med 2021; 187:e577-e588. [PMID: 34368853 DOI: 10.1093/milmed/usab318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/16/2021] [Accepted: 07/14/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The Psychological Health Center of Excellence conducted a rapid review of the literature to investigate the effectiveness of behavioral health treatments (i.e., evidence-based psychotherapy and psychiatry) delivered in person compared to telehealth (TH; i.e., video teleconference and telephone). MATERIALS AND METHODS The rapid review methods included a systematic search of a single database (PubMed), hand-searching of relevant systematic reviews, dual screening, single-person data abstraction verified by a second person, and dual risk of bias assessment. Due to heterogeneity across studies, no quantitative analyses were conducted. RESULTS Twenty-two randomized controlled trials (RCTs), eight of which were non-inferiority trials, evaluated the effectiveness of TH via telephone or video teleconferencing compared to in-person (IP) delivery for patient populations with posttraumatic stress disorder, depression, and mixed diagnoses. The majority of RCTs and all but one of the eight non-inferiority trials found that clinical outcomes did not differ between TH and IP treatment delivery. Two studies found that subgroups with higher symptom severity (hopelessness and anxiety disorders, respectively) in the TH group had worse treatment-related outcomes than IP participants with similar symptom profiles. The majority of studies found no significant differences in satisfaction with care, quality of the therapeutic alliance, or study discontinuation between TH and IP groups. CONCLUSION Based on evidence from 22 RCTs, the use of TH platforms, including video conference and telephone modalities, generally produces similar outcomes as face-to-face provision of psychotherapy and psychiatry services.
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Affiliation(s)
- Dawn M Bellanti
- Psychological Health Center of Excellence (PHCoE), Research Branch, Research & Development Division (J-9), Defense Health Agency, Silver Spring, MD 20910, USA
| | - Marija S Kelber
- Psychological Health Center of Excellence (PHCoE), Research Branch, Research & Development Division (J-9), Defense Health Agency, Silver Spring, MD 20910, USA
| | - Don E Workman
- Veterans Health Administration, Office of Research Development, Washington, DC 20402, USA
| | - Erin H Beech
- Psychological Health Center of Excellence (PHCoE), Research Branch, Research & Development Division (J-9), Defense Health Agency, Silver Spring, MD 20910, USA
| | - Brad E Belsher
- Phoenix VA Health Care System, Carl T Hayden Veterans Medical Center, Phoenix, AZ 85012, USA
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Lewinski AA, Sullivan C, Allen KD, Crowley MJ, Gierisch JM, Goldstein KM, Gray K, Hastings SN, Jackson GL, McCant F, Shapiro A, Tucker M, Turvey C, Zullig LL, Bosworth HB. Accelerating Implementation of Virtual Care in an Integrated Health Care System: Future Research and Operations Priorities. J Gen Intern Med 2021; 36:2434-2442. [PMID: 33496928 PMCID: PMC8342733 DOI: 10.1007/s11606-020-06517-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Virtual care is critical to Veterans Health Administration (VHA) efforts to expand veterans' access to care. Health care policies such as the Veterans Access, Choice, and Accountability (CHOICE) Act and the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act impact how the VHA provides care. Research on ways to refine virtual care delivery models to meet the needs of veterans, clinicians, and VHA stakeholders is needed. OBJECTIVE Given the importance of virtual approaches for increasing access to high-quality VHA care, in December 2019, we convened a Think Tank, Accelerating Implementation of Virtual Care in VHA Practice, to consider challenges to virtual care research and practice across the VHA, discuss novel approaches to using and evaluating virtual care, assess perspectives on virtual care, and develop priorities to enhance virtual care in the VHA. METHODS We used a participatory approach to develop potential priorities for virtual care research and activities at the VHA. We refined these priorities through force-ranked prioritization and group discussion, and developed solutions for selected priorities. RESULTS Think Tank attendees (n = 18) consisted of VHA stakeholders, including operations partners (e.g., Office of Rural Health, Office of Nursing Services, Health Services Research and Development), clinicians (e.g., physicians, nurses, psychologists, physician assistants), and health services researchers. We identified an initial list of fifteen potential priorities and narrowed these down to four. The four priorities were (1) scaling evidence-based practices, (2) centralizing virtual care, (3) creating high-value care within the VHA with virtual care, and (4) identifying appropriate patients for virtual care. CONCLUSION Our Think Tank took an important step in setting a partnered research agenda to optimize the use of virtual care within the VHA. We brought together research and operations stakeholders and identified possibilities, partnerships, and potential solutions for virtual care.
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Affiliation(s)
- Allison A Lewinski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.
- School of Nursing, Duke University, Durham, NC, USA.
- HSR&D COIN (558/152), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
| | - Caitlin Sullivan
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Kelli D Allen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew J Crowley
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer M Gierisch
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Karen M Goldstein
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Kaileigh Gray
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Susan N Hastings
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - George L Jackson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Felicia McCant
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Abigail Shapiro
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Matthew Tucker
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Carolyn Turvey
- Comprehensive Access and Delivery Research and Evaluation Center, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Iowa City Veterans Rural Health Resource Center, Iowa City, IA, USA
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Leah L Zullig
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Hayden B Bosworth
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Frye WS, Gardner L, Mateus JS. Utilising telemental health in a paediatric outpatient psychology clinic: Therapeutic alliance and outcomes. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Lauren Gardner
- Johns Hopkins All Children’s Hospital St Petersburg FL USA
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Der-Martirosian C, Heyworth L, Chu K, Mudoh Y, Dobalian A. Patient Characteristics of VA Telehealth Users During Hurricane Harvey. J Prim Care Community Health 2021; 11:2150132720931715. [PMID: 32507009 PMCID: PMC7278288 DOI: 10.1177/2150132720931715] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction: Research on patient characteristics of telehealth users is relatively new. More studies are needed to understand the characteristics of telehealth users during disasters. This study attempts to bridge this gap and examines patient characteristics of telehealth users compared with nontelehealth users at the Houston VA Medical Center (VAMC) immediately before and after Hurricane Harvey (2017). Methods: Since use of telehealth services reached its peak and gradually declined within 2 weeks after the landfall, the data analyses focused on 14 days before/14 days after Harvey. Two sets of analyses were conducted using chi-square, t test, and one-way analysis of variance: (1) Patient characteristics of telehealth users were compared with nontelehealth users. (2) Patient characteristics were compared between 3 subgroups of telehealth users. Results: Compared with nontelehealth users, telehealth users were older (mean age: 60.8 vs 58.5 years, P < .001) and had a higher mean Nosos health risk score (1.9 vs 1.4, P < .001). They also had a higher mean number of outpatient visits (28.0 vs 19.8, P < .001), higher emergency room use (37% vs 29%, P < .001), and higher rates of hospitalizations (21% vs 13%, P < .001) during the 12 months before Harvey. When compared to less frequent telehealth users, the most frequent telehealth users were the oldest and most medically complex patients. Conclusions: As the largest integrated health care system in the United States, the VA has many advantages favoring successful implementation of telehealth services during disasters. However, more research is needed to better understand how VA telehealth could meet the varying needs of veterans to lower risk of harm during differing types of disasters.
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Affiliation(s)
- Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | | | - Karen Chu
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | - Yvonne Mudoh
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA.,University of Memphis School of Public Health, Memphis, TN, USA
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Schoebel V, Wayment C, Gaiser M, Page C, Buche J, Beck AJ. Telebehavioral Health During the COVID-19 Pandemic: A Qualitative Analysis of Provider Experiences and Perspectives. Telemed J E Health 2021; 27:947-954. [PMID: 34028302 DOI: 10.1089/tmj.2021.0121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Due to the COVID-19 pandemic and prompted by recent federal and state policy shifts impacting behavioral health care delivery, the use of telebehavioral health has rapidly increased. This qualitative study describes behavioral health provider perspectives on the use of telebehavioral health before and during the pandemic and how policy changes impacted access to and utilization of behavioral health services in Michigan. Materials and Methods: A convenience sample of 31 licensed and nonlicensed behavioral health providers operating in Michigan participated in semi-structured interviews between July and August 2020. Interviews were audio-recorded, transcribed, and analyzed by using inductive methods. Results: The thematic analysis resulted in four overarching themes: (1) increased access to care; (2) maintenance of quality of care; (3) minimal privacy concerns; and (4) client and provider satisfaction. Discussion: During and post-pandemic, providers need flexibility to determine whether in-person or telebehavioral health services, including audio-only, best meet client needs. Providers identified several populations for which telebehavioral health was less accessible: clients with serious mental illness and substance use disorder, those with no broadband Internet access, children, and older adults. Additional training in telebehavioral health service provision can positively impact quality of care. Conclusion: Policies that support reimbursement parity and expand provider use of telebehavioral health services should be maintained after the COVID-19 pandemic ends to avoid imposing barriers to accessing behavioral health care barriers post-pandemic.
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Affiliation(s)
- Victoria Schoebel
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Caitlyn Wayment
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.,Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine, Aurora, Colorado, USA
| | - Maria Gaiser
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Cory Page
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jessica Buche
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Angela J Beck
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Abram MD, Guilamo-Ramos V, Lobelo A, Forbes MO, Caliendo G. Telehealth Simulation of Psychiatric and Chronic Disease Comorbidity: Response to the COVID-19 National Epidemic. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fischer EP, Curran GM, Fortney JC, McSweeney JC, Williams DK, Williams JS. Impact of Attitudes and Rurality on Veterans' Use of Veterans Health Administration Mental Health Services. Psychiatr Serv 2021; 72:521-529. [PMID: 33691490 PMCID: PMC8638372 DOI: 10.1176/appi.ps.201900275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Veterans, especially those residing in rural areas, continue to underutilize mental health care. This longitudinal study assessed attitudes relevant to seeking mental health care services from the Veterans Health Administration (VHA) over 12 months, adjusting for residence. METHODS A questionnaire addressing attitudes, sociodemographic factors, residence, place identity, perceived health status and needs, and structural barriers was administered by telephone to 752 veterans with previous VHA service use. Service use data were obtained from a VHA database. RESULTS In adjusted models, four attitudes were significantly associated with underuse of VHA mental health care (no use vs. any use; no use vs. nonsustained use vs. sustained use). Higher levels of mistrust of others (adjusted odds ratio [AOR]=1.06, p=0.046), emotional stoicism (AOR=1.08, p=0.003), belief in the self-resolving nature of mental health problems (AOR=1.91, p=0.015), and belief in the efficacy of religious counseling for such problems (AOR=1.09, p=0.022) were associated with no subsequent service use versus any use. Place identity (suburban), older age, and greater need were associated with greater odds of VHA use. For the comparison of no use versus sustained use, women had lower odds of no use (AOR=0.49, p<0.001); similarly, women had lower odds of nonsustained use versus sustained use (AOR=0.45, p<0.001). CONCLUSIONS The association of potentially modifiable attitudes with underuse of VHA mental health services suggests that attitudes offer useful targets for efforts to increase mental health care use. That these attitudes were influential regardless of residence suggests that programs addressing attitudinal barriers can be broadly targeted.
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Affiliation(s)
- Ellen P Fischer
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Fischer, Curran, J. S. Williams); Department of Psychiatry, College of Medicine (Fischer), Department of Pharmacy Practice, College of Pharmacy (Curran), Department of Nursing Science, College of Nursing (McSweeney), and Department of Biostatistics (D. K. Williams), University of Arkansas for Medical Sciences, Little Rock; Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, University of Washington School of Medicine, Seattle (Fortney)
| | - Geoffrey M Curran
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Fischer, Curran, J. S. Williams); Department of Psychiatry, College of Medicine (Fischer), Department of Pharmacy Practice, College of Pharmacy (Curran), Department of Nursing Science, College of Nursing (McSweeney), and Department of Biostatistics (D. K. Williams), University of Arkansas for Medical Sciences, Little Rock; Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, University of Washington School of Medicine, Seattle (Fortney)
| | - John C Fortney
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Fischer, Curran, J. S. Williams); Department of Psychiatry, College of Medicine (Fischer), Department of Pharmacy Practice, College of Pharmacy (Curran), Department of Nursing Science, College of Nursing (McSweeney), and Department of Biostatistics (D. K. Williams), University of Arkansas for Medical Sciences, Little Rock; Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, University of Washington School of Medicine, Seattle (Fortney)
| | - Jean C McSweeney
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Fischer, Curran, J. S. Williams); Department of Psychiatry, College of Medicine (Fischer), Department of Pharmacy Practice, College of Pharmacy (Curran), Department of Nursing Science, College of Nursing (McSweeney), and Department of Biostatistics (D. K. Williams), University of Arkansas for Medical Sciences, Little Rock; Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, University of Washington School of Medicine, Seattle (Fortney)
| | - D Keith Williams
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Fischer, Curran, J. S. Williams); Department of Psychiatry, College of Medicine (Fischer), Department of Pharmacy Practice, College of Pharmacy (Curran), Department of Nursing Science, College of Nursing (McSweeney), and Department of Biostatistics (D. K. Williams), University of Arkansas for Medical Sciences, Little Rock; Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, University of Washington School of Medicine, Seattle (Fortney)
| | - J Silas Williams
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Fischer, Curran, J. S. Williams); Department of Psychiatry, College of Medicine (Fischer), Department of Pharmacy Practice, College of Pharmacy (Curran), Department of Nursing Science, College of Nursing (McSweeney), and Department of Biostatistics (D. K. Williams), University of Arkansas for Medical Sciences, Little Rock; Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, University of Washington School of Medicine, Seattle (Fortney)
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