Forging New Paths to Integrate Rural Veterans’ Care Nationwide

Lee, Jennifer; Capra, Gina; Klobucar, Thomas F.

doi:10.1111/jrh.12214

Cited by 9 publications

(6 citation statements)

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“…Gaining a better understanding of the respective contributions of these factors will help identify points of intervention, such as offering internet or smartphone subsidies; increasing network connectivity; or providing digital literacy training to increase comfort, confidence, and openness toward new technologies [40]. As a growing number of initiatives introduce technology-based interventions into rural communities in efforts to improve access, including within the VA [41], it will be of particular importance to acknowledge and address these barriers to uptake.…”

Section: Discussionmentioning

confidence: 99%

Veterans’ Attitudes Toward Smartphone App Use for Mental Health Care: Qualitative Study of Rurality and Age Differences

Connolly¹,

Miller²,

Koenig³

et al. 2018

JMIR Mhealth Uhealth

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BackgroundMental health smartphone apps provide support, skills, and symptom tracking on demand and come at minimal to no additional cost to patients. Although the Department of Veterans Affairs has established itself as a national leader in the creation of mental health apps, veterans’ attitudes regarding the use of these innovations are largely unknown, particularly among rural and aging populations who may benefit from increased access to care.ObjectiveThe objective of our study was to examine veterans’ attitudes toward smartphone apps and to assess whether openness toward this technology varies by age or rurality.MethodsWe conducted semistructured qualitative interviews with 66 veterans from rural and urban areas in Maine, Arkansas, and California. Eligible veterans aged 18 to 70 years had screened positive for postraumatic stress disorder (PTSD), alcohol use disorder, or major depressive disorder, but a history of mental health service utilization was not required. Interviews were digitally recorded, professionally transcribed, and coded by a research team using an established codebook. We then conducted a thematic analysis of segments pertaining to smartphone use, informed by existing theories of technology adoption.ResultsInterviews revealed a marked division regarding openness to mental health smartphone apps, such that veterans either expressed strongly positive or negative views about their usage, with few participants sharing ambivalent or neutral opinions. Differences emerged between rural and urban veterans’ attitudes, with rural veterans tending to oppose app usage, describe smartphones as hard to navigate, and cite barriers such as financial limitations and connectivity issues, more so than urban populations. Moreover, rural veterans more often described smartphones as being opposed to their values. Differences did not emerge between younger and older (≥50) veterans regarding beliefs that apps could be effective or compatible with their culture and identity. However, compared with younger veterans, older veterans more often reported not owning a smartphone and described this technology as being difficult to use.ConclusionsOpenness toward the use of smartphone apps in mental health treatment may vary based on rurality, and further exploration of the barriers cited by rural veterans is needed to improve access to care. In addition, findings indicate that older patients may be more open to integrating technology into their mental health care than providers might assume, although such patients may have more trouble navigating these devices and may benefit from simplified app designs or smartphone training. Given the strong opinions expressed either for or against smartphone apps, our findings suggest that apps may not be an ideal adjunctive treatment for all patients, but it is important to identify those who are open to and may greatly benefit from this technology.

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Section: Discussionmentioning

confidence: 99%

Veterans’ Attitudes Toward Smartphone App Use for Mental Health Care: Qualitative Study of Rurality and Age Differences

Connolly¹,

Miller²,

Koenig³

et al. 2018

JMIR Mhealth Uhealth

View full text Add to dashboard Cite

show abstract

“…1,2 Yet, many veterans, especially rural veterans, face challenges accessing primary care services due to extensive wait times for appointments, shortages of available, qualified health care providers, and long drive distances to facilities. [3][4][5][6] In response to these barriers, the VHA initiated a pilot program called the Virtual Integrated Patient-Aligned Care Teams (V-IMPACT) to increase access to primary care services through delivery of teleprimary care in a team-based environment and with the use of PACT principles--coordinated, collaborative, comprehensive, interdisciplinary care. 7 V-IMPACT used a hub-and-spoke model comprised of an interdisciplinary hub team of remote primary care providers (PCPs), nurse coordinators, pharmacists, and social workers who delivered care to patients in smaller, remote spoke sites mostly through secure, video telehealth appointments, with the help of local clinical staff (nurses, medical assistants, and clerks).…”

Section: Introductionmentioning

confidence: 99%

“…The Veterans Health Administration (VHA) has been a leader in delivering health services through interactive clinical telemedicine and the patient‐centered medical home model (Patient Aligned Care Teams‐PACT) prior to the COVID‐19 pandemic 1,2 . Yet, many veterans, especially rural veterans, face challenges accessing primary care services due to extensive wait times for appointments, shortages of available, qualified health care providers, and long drive distances to facilities 3–6 …”

Section: Introductionmentioning

confidence: 99%

Rural and urban differences in the implementation of Virtual Integrated Patient‐Aligned Care Teams

Scott

Chow

et al. 2022

The Journal of Rural Health

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Purpose Workforce shortages contribute to geographic disparities in accessing primary care services. An innovative, clinic‐to‐clinic videoconferencing telehealth program in the Veterans Health Administration (VHA) called the Virtual Integrated Patient‐Aligned Care Teams (V‐IMPACT) was designed to increase veterans’ access to primary care and relieve workforce shortages in VA primary care clinics, including in many rural areas. This paper describes trends in clinic sites and veteran uptake of the V‐IMPACT program, a model that delivered remote, team‐based primary care services, from fiscal years (FY)2013‐2018. Methods This observational study used VHA administrative data to compare program uptake, measured by the program penetration rate (percent of patients using V‐IMPACT services in each site) across sites; and characteristics for V‐IMPACT users versus nonusers for 2,155,203 veteran‐years in 69 sites across 7 regional networks for FY2013‐2018. Regression models assessed the association between V‐IMPACT use and veteran characteristics within sites. Findings Across sites, V‐IMPACT had higher penetration in rural sites (8%) and primary care community‐based outpatient clinics (7%, P<.001). After adjusting for veteran characteristics, rural veterans (aOR = 1.05; P = .02) and veterans with higher comorbidity risk scores (aOR = 1.08; P<.001) were independently associated with V‐IMPACT use. Highly rural veterans (OR = 0.60; P<.001) and veterans who lived ≥40 miles from the closest VHA primary care site (OR = 0.86; P<.001) were less likely to be a V‐IMPACT user. Conclusions A clinic‐to‐clinic telehealth program, such as V‐IMPACT, was able to reach many rural sites, rural veterans, and veterans in primary care health professional shortage areas. V‐IMPACT has the potential to increase access to team‐based primary care.

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“…Given the VA's substantial investments since 2015 to address the challenges with CC in the early implementation period, [23][24][25] we expected rural Veterans' experiences in CC to improve over time. Some of these investments, such as community provider training on military culture and posttraumatic stress disorder, more expansive care coordinator functions, and infrastructure to support health information exchange, might have contributed to improvements in Veterans' ratings of CC providers and their experiences with CC access and coordination.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Forging New Paths to Integrate Rural Veterans’ Care Nationwide

Cited by 9 publications

References 0 publications

Veterans’ Attitudes Toward Smartphone App Use for Mental Health Care: Qualitative Study of Rurality and Age Differences

Veterans’ Attitudes Toward Smartphone App Use for Mental Health Care: Qualitative Study of Rurality and Age Differences

Rural and urban differences in the implementation of Virtual Integrated Patient‐Aligned Care Teams

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

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