Veterans Access Research Articles

Rural Veterans' Experiences With Outpatient Care in the Veterans Health Administration Versus Community Care.

The 2014 Veterans Access, Choice and Accountability Act was intended to improve Veterans' access to timely health care by expanding their options to receive community care (CC) paid for by the Veterans Health Administration (VA). Although CC could particularly benefit rural Veterans, we know little about rural Veterans' experiences with CC. The objective of this study was to compare rural Veterans' experiences with CC and VA outpatient health care services to those of urban Veterans and examine changes over time. Retrospective, cross-sectional study using data from the Survey of Healthcare Experiences of Patients (SHEP) and VA Corporate Data Warehouse. Subjects: All Veterans who responded to the SHEP survey in Fiscal Year (FY) 16 or FY19. Outcomes were 4 measures of care experience (Access, Communication, Coordination, and Provider Rating). Independent variables included care setting (CC/VA), rural/urban status, and demographic and clinical characteristics. Compared with urban Veterans, rural Veterans rated CC the same (for specialty care) or better (for primary care). Rural Veterans reported worse experiences in CC versus VA, except for specialty care Access. Rural Veterans' care experiences improved between FY16 and FY19 in both CC and VA, with greater improvements in CC. Rural Veterans' reported comparable or better experiences in CC compared with urban Veterans, but rural Veterans' CC experiences still lagged behind their experiences in VA for primary care. As growing numbers of Veterans use CC, VA should ensure that rural and urban Veterans' experiences with CC are at least comparable to their experiences with VA care.

Patient experiences with telehealth in sleep medicine: a qualitative evaluation.

The field of sleep medicine has been an avid adopter of telehealth, particularly during the COVID-19 pandemic. The goal of this study was to assess patients' experiences receiving sleep care by telehealth. From June 2019 to May 2020, the authors recruited a sample of patients for semi-structured interviews, including patients who had 1 of 3 types of telehealth encounters in sleep medicine: in-clinic video, home-based video, and telephone. Two analysts coded transcripts using content analysis and identified themes that cut across patients and categories. The authors conducted interviews with 35 patients and identified 5 themes. (1) Improved access to care: Patients appreciated telehealth as providing access to sleep care in a timely and convenient manner. (2) Security and privacy: Patients described how home-based telehealth afforded them greater feelings of safety and security due to avoidance of anxiety-provoking triggers (eg, crowds). Patients also noted a potential loss of privacy with telehealth. (3) Personalization of care: Patients described experiences with telehealth care that either improved or hindered their ability to communicate their needs. (4) Patient empowerment: Patients described how telehealth empowered them to manage their sleep disorders. (5) Unmet needs: Patients recognized specific areas where telehealth did not meet their needs, including the need for tangible services (eg, mask fitting). Patients expressed both positive and negative experiences, highlighting areas where telehealth can be further adapted. As telehealth in sleep medicine continues to evolve, the authors encourage providers to consider these aspects of the patient experience. Donovan LM, Mog AC, Blanchard KN, et al. Patient experiences with telehealth in sleep medicine: a qualitative evaluation. J Clin Sleep Med. 2021;17(8):1645-1651.

Reasons Older Veterans Use the Veterans Health Administration and Non-VHA Care in an Urban Environment.

Older veterans in urban settings rely less on the Veterans Health Administration (VHA) health care, suggesting deficits of access and services for aging veterans. We aimed to identify reasons for VHA and non-VHA use across the health status of older, urban-dwelling veterans. We examined open-ended responses from 177 veterans who were enrolled in primary care at the Bronx VA Medical Center, used non-VHA care in prior 2 years, and completed baseline interviews in a care coordination trial from March 2016 to August 2017. Using content analysis, we coded and categorized key terms and concepts into an established access framework. This framework included 5 categories: acceptability (relationship, second opinion), accessibility (distance, travel); affordability; availability (supply, specialty care); and accommodation (organization, wait-time). Self-reported health status was stratified by excellent/very good, good, and fair/poor. We were able to categorize the responses of 166 veterans, who were older (≥75 years, 61%), minority race and ethnicity (77%), and low income (<$25,000/y, 51%). Veterans mentioned acceptability (42%) and accessibility (37%) the most, followed by affordability (33%), availability (25%), and accommodation (11%). With worse self-reported health status, accessibility intensified (excellent/very good, 24%; fair/poor, 46%; P = .031) particularly among minority veterans, while acceptability remained prominent (excellent/very good, 49%; fair/poor, 37%; P = .25). Other categories were mentioned less with no significant difference across health status. Even in an urban environment, proximity was a leading issue with worse health. Addressing urban accessibility and coordination for older, sicker veterans may enhance care for a growing vulnerable VHA population.

Accelerating Implementation of Virtual Care in an Integrated Health Care System: Future Research and Operations Priorities.

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. 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. 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. 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. 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.

Getting Food to the Table: Challenges, Strategies, and Compromises Experienced by Low-Income Veterans Raising Children

ABSTRACT Using photo-elicitation, 17 low-income, post-9/11 Veterans with children residing in/near Houston, TX shared experiences getting food to their table. Limited money, time, and disabilities challenged access to healthy meals. Limited resources decreased choice and control over what Veterans fed their children. Affordable, accessible food fell below nutritional standards. Veterans rationed their own intake to preserve food for their children. Informed by Veterans’ experiences, we developed a model of three factors – resources, personal capacity, and culture – that influence quality, quantity, and type of food low-income Veterans access. Policies to help Veterans increase access to nutritious food need to consider these factors.

Responses to Concerning Posts on Social Media and Their Implications for Suicide Prevention Training for Military Veterans: Qualitative Study.

BackgroundA “concerning post” is a display of a user’s emotional crisis on a social media platform. A better understanding of concerning posts is relevant to suicide prevention, but little is known about social media users’ attitudes and responses to concerning posts. Military veterans in the United States are disproportionately affected by suicide, often use social media, and may have exposure to individuals with elevated suicide risk via concerning posts.ObjectiveThe objective of the study was (1) to obtain insight into whether and how US military veterans respond to members of their social network on social media (ie, “friends”) who are experiencing substantial emotional distress, and (2) to identify potential interventions that could assist in users’ response to concerning posts.MethodsWe recruited veterans through Facebook and conducted semistructured interviews with 30 participants between June and December 2017. We used a summary template for rapid analysis of each interview, followed by double-coding using a codebook based on topic domains from the interview guide. Members of the research team met regularly to discuss emerging patterns in the data, generate themes, and select representative quotes for inclusion in the manuscript.ResultsVeterans were reluctant to disclose emotional and health issues on Facebook, but they were open to reaching out to others’ concerning posts. There was a complex calculus underlying whether and how veterans responded to a concerning post, which involved considering (1) physical proximity to the person posting, (2) relationship closeness, (3) existing responses to the post, and (4) ability to maintain contact with the person. Veterans desired additional training, backed by community-based veteran organizations, in how to respond to concerning posts from peers.ConclusionsThere is a need to incorporate features that will help veterans effectively respond to concerning posts from peers into suicide prevention training and to expand access for veterans to such training.

Lessons Learned in Implementing VA Video Connect for Evidence-Based Psychotherapies for Anxiety and Depression in the Veterans Healthcare Administration.

A top priority for the Veteran’s Healthcare Administration is improving access to high-quality mental healthcare. Mobile and telemental healthcare are a vital component of increasing access for veterans. The Veteran’s Healthcare Administration is making efforts to further broaden how veterans receive their care through VA Video Connect, which allows veterans to connect with their provider from their residence or workplace. In this mixed-methods study, successes and challenges associated with the rapid implementation of VA Video Connect telemental health appointments are examined through (1) administrative data and (2) qualitative interviews at one medical center. Within 1 year of the telehealth initiative, the number of providers experienced with telemental health increased from 15% to 85%, and telehealth appointments increased from 5376 to 14,210. Provider reported barriers included administrative challenges and concerns regarding care. Having an implementation model of telehealth champions and a team of experienced mental health providers allowed for rapid adoption of telehealth. Utilizing a similar model in other settings will further enable more veterans with depression and anxiety to have access to evidence-based psychotherapy, regardless of location or national crisis. With the dramatic increase in both training for providers as well as veteran use of telemental healthcare during the COVID-19 pandemic response, future research should aim to better understand which teams were able to switch to telehealth easily versus those which struggled, along with examining system-wide and provider-level factors that facilitated continued use of telehealth after social distancing requirements related to COVID-19 were relaxed.Electronic supplementary materialThe online version of this article (10.1007/s41347-020-00161-8) contains supplementary material, which is available to authorized users.

Innovations in Care: Complementary and Integrative Health in the Veterans Health Administration Whole Health System.

Innovations in Care: Complementary and Integrative Health in the Veterans Health Administration Whole Health System.

National Geriatric Network Rapidly Addresses Trainee Telehealth Needs in Response to COVID-19.

BACKGROUND/OBJECTIVESCoronavirus disease 2019 (COVID‐19) has pushed many geriatric healthcare providers to attempt video visits for the first time. Although the Veterans Health Administration (VA) is a pioneer in telemedicine, rapid shifts to nearly exclusive use of telehealth for healthcare delivery and changes regarding trainee engagement in telehealth served as the impetus for rapidly assessing telehealth training needs.DESIGNNational needs assessment (online survey) of associated health trainees and medical fellows affiliated with Geriatric Research Education and Clinical Centers (GRECCs).SETTINGNational GRECC network ‐‐ 20 VA centers of excellence focused on supporting Veterans as they age. Each GRECC is affiliated with a school of medicine at a major university.PARTICIPANTSTrainees (n = 89) representing 12 disciplines.RESULTSTwo‐thirds of participants had received some telehealth training. However, most had never done a video‐to‐home visit, and, regardless of telehealth experience, they reported low confidence. Based on open‐ended questions exploring training needs, educational resources were rapidly developed and disseminated.INTERVENTIONWithin 1 week of the assessment, a nuts‐and‐bolts guide regarding remote access, technology requirements, video‐conferencing platforms, and managing emergencies was sent to the national network of GRECC associate directors for education for dissemination among discipline‐specific training directors at their sites. This resource was subsequently submitted to the national VA COVID Strong Practices SharePoint site. An interdisciplinary team of geriatric specialists with extensive video‐to‐home experience also organized a national webinar that peaked at just over 700 participants. GRECC Connect, a network of geriatric specialty teams funded to improve care access for rural older veterans using telehealth and associated health training programs at each GRECC facilitated rapid development and dissemination of both resources.CONCLUSIONWe quickly identified and responded to telehealth training needs of geriatrics trainees to optimize care for rural older adults as part of a rapid response to COVID‐19. Although the webinar and nuts‐and‐bolts resources were developed within the VA context, they have demonstrated high demand and broader applicability. Results should continue to inform curriculum development efforts to address telehealth training gaps within and outside the VA.

Veterans' Experiences With Outpatient Care: Comparing The Veterans Affairs System WithCommunity-Based Care.

Timely access to outpatient care was a primary driver behind the Department of Veterans Affairs' (VA's) increased purchase of community-based care under the Veterans Access, Choice, and Accountability Act of 2014, known as the Choice Act. To compare veterans' experiences in VA-delivered and community-based outpatient care after implementation of the act, we assessed veterans' scores on four dimensions of experience-access, communication, coordination, and provider rating-for outpatient specialty, primary, and mental health care received during 2016-17. Patient experiences were better for VA than for community care in all respects except access. For specialty care, access scores were better in the community; for primary and mental health care, access scores were similar in the two settings. Although all specialty care scores and the primary care coordination score improved over time, the gaps between settings did not shrink. As purchased care further expands under the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, which replaced the Choice Act in 2019, monitoring of meaningful differences between settings should continue, with the results used to inform both VA purchasing decisions and patients' care choices.

Musculoskeletal Related Disability in Veterans of Iraq and Afghanistan

Purpose: Over 60% of Iraq and Afghanistan veterans access Veterans Administration (VA) health care after military service. The purpose of this research is to describe the types of musculoskeletal service-connected disabilities distributed among these veterans. Methods: A retrospective cohort of 383,757 Iraq and Afghanistan veterans were searched for service-connected disability determinations using the Veterans Services Network Corporate Master File (VETSNET). Service-connected disabilities were grouped according to the types of diagnoses represented. Results: Of 383,757 included veterans, 347,643 (90.6%) had at least one musculoskeletal-related service-connected disability. The most common group of musculoskeletal disabilities was conditions of the spine, affecting 241, 636 (69.5%) veterans, limitations in the knee/leg motion (46.6%) and acute and chronic disorders (30.2%). The median number of musculoskeletal conditions contributing to the service connected disability per veteran was 2.8 ± 1.3 conditions. Post-Traumatic Stress Disorder was the most common primary service connected disability for both men and women. Discussion: Musculoskeletal conditions as a source of service connected disability affects 90% of veterans from Iraq and Afghanistan. While the primary source of service connected disability is most often not musculoskeletal related, the overall burden of musculoskeletal conditions is very high with an average of 2.8 musculoskeletal conditions per veteran contributing to their disability.

Examining and Improving Provider Adherence to the Primary Care Mental Health Integration Model.

The Veterans Health Administration (VHA) is a national leader in integrated care, known in the VHA as the Primary Care Mental Health Integration (PCMHI) model. This model is associated with improved quality of services and same-day access for veterans. There has been some recent development of PCMHI/integrated care competencies within VHA and across the nation. To fully implement these competencies, however, PCMHI providers must not only be trained, but their adherence to the PCMHI model must also be assessed. While there have been recent advances, there has been little research that has examined the adherence of PCMHI providers to the model or methods to improve adherence. The present study sought to examine and improve the clinical practice of a team of eight PCMHI providers to make practice more adherent to the PCMHI model. This study was conducted at a large Midwestern VA Medical Center using interventions based in assessment, feedback, and training-measured at three points in time. The Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ; Beehler GP, Funderburk JS, Possemato K, et al.: Psychometric assessment of the primary care behavioral health provider adherence questionnaire (PPAQ). Transl Behav Med 2013; 3: 379-91.) was used to assess provider adherence and the PPAQ toolkit was used to provide tailored recommendations for improving provider practice. In addition, the VHA "Foundations Manual" and Functional Tool outlined essential behavioral targets that are consistent with the PCMHI model and the "essential provider behaviors" from the PPAQ. A combination of individual and group interventions was presented and adherence, pre and post, was assessed with the PPAQ and with evaluation of clinical practice data. Results indicated that the behavior of PCMHI providers changed over time, with providers exhibiting more PCMHI consistent behaviors and fewer inconsistent behaviors. Adherence to the PCMHI model increased. Providing assessment, feedback, and training in the PCMHI model changed the clinical practice of PCMHI providers and resulted in improved adherence. Clinical and research implications are discussed.

Access to Pain Care From Compensation Clinics: A Relational Coordination Perspective

The Compensation and Pension (C&P) determination process is a potential gateway to accessing pain treatment in the Veterans Health Administration (VHA). However, attitudes about C&P as a gateway and about collaboration with C&P clinics among VHA staff are unknown. In preparation for an initiative to link veterans seeking compensation for musculoskeletal disorders to treatment, clinical and administrative staff from the 8 VHA medical centers in New England were invited to complete a relational coordination survey that examined how different workgroups collaborate (communication and relationships) to provide pain care to veterans. A subset of those staff also participated in a semistructured interview about pain treatment referral practices within their medical centers. VHA staff were from primary care, administration, pain management, and C&P teams. Eighty-three VHA staff were invited to complete the relational coordination survey; 66 completed the survey and 39 participated in the semistructured interview. Most C&P staff interviewed thought of the compensation examination as a forensic process and that C&P-based efforts to engage veterans might interfere with the examination or were not their responsibility. However, some examiners described their efforts to determine new veterans' eligibility for VHA care and to connect them to specific treatments. VHA staff reported that there was little communication between the C&P team and other teams. The survey results supported this finding. The C&P group's relational coordination composite scores were lower than any other workgroup. Outreach to veterans at New England C&P clinics was inconsistent, and C&P teams rated low on a measure of coordination with workgroups involved in pain treatment. Compensation examinations appear to be underused opportunities to help veterans access treatment. C&P-based treatment engagement is feasible; it is being done by some Compensation teams.

Comparing VA and Community-Based Care: Trends in Sleep Studies Following the Veterans Choice Act.

To address concerns about access to care, the Veterans Access, Choice, and Accountability Act of 2014 was enacted to make care available in the community when Veterans Health Administration (VA) care was unavailable or not timely. This paper examined VA referrals for diagnostic sleep studies from federal fiscal year (FY) 2015-2018. Sleep studies completed between FY2015 and 2018 for Veterans tested within VA facilities (VAF) or referred to VA community care (VACC) providers were identified using VA administrative data files. Sleep studies were divided into laboratory and home studies. The number of sleep studies conducted increased over time; the proportion of home studies increased in VAF (32 to 47%). Veterans were more likely to be referred for a sleep study to VACC if they lived in a rural or highly rural area (ORs = 1.47 and 1.55, respectively), and had public or public and private insurance (ORs = 2.01 and 1.35), and were less likely to be referred to VACC if they were age 65+ (OR = 0.72) and were in the highest utilization risk based on Nosos score (OR = 0.78). Regression analysis of sleep study type revealed that lab studies were much more likely for VACC referrals (OR = 3.16), for persons living in rural areas (OR = 1.21), with higher comorbidity scores (OR = 1.28) and for ages 44-54, 55 to 64, and 65+ (ORs = 1.12, 1.28, 1.45, respectively) compared to younger Veterans. Veterans with some or full VA copayments (ORs = 0.91 and 0.86, respectively), and overweight Veterans (OR = 0.94) were less likely to have lab studies. The number of sleep studies performed on Veterans increased from 2015 to 2018. Access to sleep studies improved through a combination of providing care through the Veteran Choice Program, predominantly used by rural Veterans, and increased use of home sleep studies by VA.

Association Between a Temporary Reduction in Access to Health Care and Long-term Changes in Hypertension Control Among Veterans After a Natural Disaster

Temporary disruptions in health care access are common, but their associations with chronic disease control remain unknown. To evaluate whether long-term changes in chronic disease control were associated with a temporary 6-month decrease in access to health care services. This cohort study examined the long-term changes in chronic disease control associated with the 6-month closure of the Manhattan facility of the Veterans Affairs (VA) New York Harbor Healthcare System after superstorm Sandy, which caused a significant disruption in health care access for veterans in the region. Electronic health records from the VA Healthcare System between October 29, 2010, and October 29, 2014, were used to identify a total of 81 544 veterans who were and were not exposed to the 6-month closure of the VA Manhattan Medical Center after superstorm Sandy. Of those, 19 207 veterans were included in the exposed cohort and 62 337 were included in the nonexposed control cohort, which included veterans who were equally exposed to the storm but who retained regular access to health care from 3 VA medical centers (Brooklyn and the Bronx in New York and New Haven in Connecticut) during and after the storm. A difference-in-differences analysis was used to assess within-patient changes in chronic disease control over time between a cohort that was exposed to decreased health care access compared with a similar cohort that was not exposed to decreased access. All analyses adjusted for individual demographic and socioeconomic characteristics, between-zip code differences, and common time trends. Data analyses were conducted between February 1, 2016, and September 30, 2019. The 6-month closure of the VA Manhattan Medical Center after superstorm Sandy on October 29, 2012. The outcomes measured were uncontrolled blood pressure (defined as mean blood pressure per patient per quarter >140/90 mm Hg), uncontrolled diabetes (defined as mean hemoglobin A1c per patient per quarter >8%), uncontrolled cholesterol (defined as mean low density lipoprotein per patient per quarter >140 mg/dL), and patient weight. Among the 81 544 veterans included in the study, the mean (SD) age was 62.1 (17.6) years, and 93.6% were men, 62.7% were white, and 31.8% were black. At the 3-month midpoint of the 6-month facility closure of the VA Manhattan Medical Center, an absolute decrease of 24.8% (95% CI, -26.5% to -23.0%; P < .001) was observed in the percentage of veterans who had any VA primary care visit per quarter compared with a baseline of 47.8% before the closure (relative decrease, 51.9%; 95% CI, -55.4% to -48.1%; P < .001). One year after the facility reopened, no differential change was observed in the percentage of patients with a primary care visit between the exposed vs nonexposed cohorts (absolute decrease, -0.1%; 95% CI, -1.5% to 1.4%; P = .94); however, patients in the exposed cohort were 25.9% more likely to have uncontrolled blood pressure than patients in the nonexposed cohort (unadjusted increase, 5.5% in the exposed cohort vs 1.3% in the nonexposed cohort; adjusted absolute increase, 5.0%; 95% CI, 3.5%-6.0%; P < .001). Two years after superstorm Sandy, patients in the exposed cohort were 10.9% more likely to experience uncontrolled blood pressure than those in the nonexposed cohort (unadjusted increase, 5.2% in the exposed cohort vs 3.5% in the nonexposed cohort; adjusted absolute increase, 2.1%; 95% CI, 0.5%-3.6%; P < .001). Compared with the nonexposed cohort, the exposed cohort also experienced a decrease in filled medication prescriptions per patient per quarter of 6.9% during the facility closure (absolute decrease, -0.7 prescriptions filled per patient per quarter; 95% CI, -0.9 to -0.5; P < .001) and of 2.2% a year after the facility reopened (absolute decrease, -0.2 prescriptions filled per patient per quarter; 95% CI, -0.4 to -0.1; P = .04). No differential changes were observed in uncontrolled diabetes, uncontrolled cholesterol, or patient weight. In this study, a temporary period of decreased access to health care services was associated with increased rates of uncontrolled hypertension, but not with increased rates of uncontrolled diabetes or hyperlipidemia, more than 1 year after the Manhattan VA facility reopened. Temporary gaps in access to health care may be associated with long-term increases in uncontrolled blood pressure among patients with hypertension.

HOME VIDEO TELEHEALTH TO SUPPORT RURAL VETERAN CAREGIVERS

VA offers multiple programs and services to support caregivers of US military Veterans. However, access for rural Veterans and caregivers is challenging due to distance from VA medical facilities. VA Video Connect (VVC) is a remote healthcare platform that enables Veterans to connect directly with VA clinicians through a secure, encrypted video connection. Rural caregivers and Veterans can participate in caregiver services through their own computer or another device from their home, reducing the need for travel to distant VA facilities. In 2018, VA’s Caregiver Support Program and Office of Rural Health developed an implementation pilot to engage eighteen VA Caregiver Support Coordinators (CSCs) in using VVC to monitor and support 180 Veteran/caregiver dyads enrolled in VA’s Program of Comprehensive Assistance for Family Caregivers. The presentation will provide an overview of each phase of implementation, report usability and outcome data from CSCs and caregivers, and discuss implications for broader implementation.

ADAPTING MINDFULNESS-BASED COUNSELING FOR THE TELEPHONE: A PILOT STUDY FOR CAREGIVERS AND VETERANS WITH DEMENTIA

Optimizing Dementia Care in Veterans with Dementia is a randomized, controlled, pilot study examining outcomes for Veterans and their caregivers at 6- and 12-months for two telephone-based interventions: a) Benjamin Rose Institute’s (BRI) Care Consultation (CC), and b) CC + Counseling (CC+C). Counseling modules are integrated into the existing BRI CC framework using guided mindfulness-based skill-building exercises on various content domains (e.g., grief, identity, intimacy, stress management). Sixty-four caregivers and 47 Veterans (M = 74.3 years, MOCA Score M = 15.5) have been randomized in this ongoing pilot study. Caregivers are 91% female, 32% Black/African American, and 72% spouses. Preliminary implementation and 6-month outcome data is discussed (e.g., reaction to behavioral distress, mindfulness, depression, quality of life) using within-group paired samples t-tests for the 32 dyads randomized to CC+C. Lessons learned include strategies for adapting mindfulness-based approaches over the telephone to enhance access for Veterans and caregivers across geographic regions.

VA Program Allows Vets to Access MH Care in Community

VA Program Allows Vets to Access MH Care in Community

Providers' perceptions on barriers and facilitators to prescribing naloxone for patients at risk for opioid overdose after implementation of a national academic detailing program: A qualitative assessment.

Academic detailing is an educational outreach program that aligns providers' prescribing with evidence-based practice. The U.S. Department of Veterans Affairs (VA) Opioid Overdose Education and Naloxone Distribution (OEND) Program partnered with the VA Pharmacy Benefits Management National Academic Detailing Service to deliver naloxone education to providers who cared for patients at risk of opioid overdose. In this pilot study, we interviewed providers' who received academic detailing to capture their perceptions of facilitators and barriers to prescribing naloxone. To identify providers' perceptions of facilitators and barriers to prescribing naloxone for patients at risk for opioid overdose after implementation of a national academic detailing program. This was a hybrid inductive-deductive qualitative pilot using semi-structured interviews with VA providers to explore constructs associated with facilitators and barriers to prescribing take-home naloxone to patients at risk for opioid overdose from August 2017 to April 2018. Eleven participants were interviewed, six physicians, three clinical psychiatric pharmacists, and two nurse practitioners. Participants identified patient-level barriers (social stigma and lack of homeless patient support), poor data integration, and burden of data validation as barriers to prescribing naloxone. However, they also identified patient lists, repeat visits, and face-to-face/one-on-one video conferencing visits as important facilitators for naloxone prescribing. Academic detailing will need to address issues of social stigma regarding naloxone, educate providers about existing support systems for homeless veterans, and develop tools for data integration to improve naloxone access for veterans at risk for an opioid overdose.

Video-Enabled Tablets Improve MH Access for Veterans

Back to table of contents Previous article Next article Clinical & ResearchFull AccessVideo-Enabled Tablets Improve MH Access for VeteransTerri D’ArrigoTerri D’ArrigoSearch for more papers by this authorPublished Online:19 Sep 2019https://doi.org/10.1176/appi.pn.2019.9b4AbstractPsychotherapy appointments increased among veterans who received tablets as part of a Veterans Health Administration program.A Veterans Health Administration program that provides video-enabled tablets to veterans who live in rural areas, lack transportation, or face other barriers to care improves both access to mental health care and continuity of care, a study in Psychiatric Services in Advance has found.iStock/WavebreakmediaJosephine C. Jacobs, Ph.D., a health economist at the VA Health Economics Resource Center in Menlo Park, Calif., and colleagues compared the health records of 728 patients who received a tablet between May 2016 and September 2017 with those of 1,020 patients in a control group who did not receive a tablet. All patients had at least one mental health condition.On average, tablet recipients participated in two additional psychotherapy appointments in the six months after receiving the devices, whereas psychotherapy visits declined for those in the control group. Tablet recipients had more encounters with mental health professionals regarding medications, were more likely to have participated in at least three psychotherapy visits in a six-week period (a measure of continuity of care), and missed or canceled a smaller proportion of their scheduled appointments than participants in the control group. There were no significant differences between the two groups in number of emergency department or urgent care visits.“Virtual care may be appealing when veterans feel anxious in the VA setting or when they have other health issues that make it difficult to attend appointments in person.” —Donna Zulman, M.D., M.S.“Mental health care may be particularly well suited to virtual modalities because in most cases therapy does not require a physical exam,” said study researcher Donna Zulman, M.D., M.S., a physician investigator at the Center for Innovation to Implementation in the VA Palo Alto Health Care System.Zulman, an assistant professor in the Division of Primary Care and Population Health at Stanford University, noted the complex medical, mental health, and social challenges that many of the patients included in the analysis face: Approximately 75% of the patients had three or more chronic conditions, more than 31% had at least two mental health diagnoses, and roughly 42% had posttraumatic stress disorder. Furthermore, more than 42% lived in rural areas.Want to Learn More About Military and Veteran Mental Health?APA, in collaboration with the Society of Uniformed Services Psychiatrists, offers continuing medical education about military and veteran mental health. The courses are posted here and include the following:Disaster Mental Health: Practical Applications of Disaster Mental Health—Lessons Learned From the U.S. MilitaryAssessment of Access to WeaponsPTSD: Pathophysiology, Treatment, and Military AspectsResilience of Military Children and FamiliesSuicide in the MilitaryAPA offers additional resources here.“It is easy to see how burdensome it might be to navigate such a high volume of health care, especially when the closest health care facility is an hour or two away,” Zulman told Psychiatric News. “For some of these patients, virtual care will be a challenge, but our findings suggest that for the patients who use tablets, the technology may facilitate critical access and continuity. In addition, the virtual care option can be appealing when veterans feel anxious in the VA setting or when they have other health issues that make it difficult to attend appointments in person.”This study was supported by the U.S. Department of Veterans Affairs Rural Health Enterprise Wide Initiative and the eHealth Partnered Evaluation Initiative. ■“Increasing Mental Health Care Access, Continuity, and Efficiency for Veterans Through Telehealth With Video Tablets” is posted here. ISSUES NewArchived