Use of Video Telehealth Tablets to Increase Access for Veterans Experiencing Homelessness

Garvin, Lynn; Hu, Junjie; Slightam, Cindie; McInnes, D. Keith; Zulman, Donna M.

doi:10.1007/s11606-021-06900-8

Cited by 45 publications

(46 citation statements)

References 54 publications

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“…Beyond patient characteristics, one key finding is the significant variation in site characteristics. Even though there are no studies that have studied PC telehealth use in VA medical centers compared to surrounding community-based clinics, our study finding, which indicates that Veterans at GLA community-based clinics were more likely to use telephone and less likely to use video use compared to Veterans receiving care at the main WLA medical facility, essentially alludes to what is known about rural vs. urban telehealth disparities inside and outside of the VA [ 55 – 60 ]. Furthermore, site variations in access to video care might be due to various factors, such as differences in bandwidth availability, clinic infrastructure, leadership buy-in, provider trainings, resources, camera-devices, and IT support.…”

Section: Discussionmentioning

confidence: 73%

Examining telehealth use among primary care patients, providers, and clinics during the COVID-19 pandemic

et al. 2022

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Background At the onset of COVID-19, there was a rapid expansion of telehealth (video/telephone) visits to maintain delivery of primary care (PC) services at the Veterans Health Administration (VA). This study examines patient, provider, and site-level characteristics of any virtual and video-based care in PC. Methods Interrupted time series (ITS) design was conducted using VA administrative/clinical, electronic healthcare data, 12-months before and 12-months after COVID-19 onset (set at March 2020) at the VA Greater Los Angeles Healthcare System (GLA), between 2019 and 2021. Patients with at least one visit to a VA PC clinic at GLA (n = 547,730 visits) were included in the analysis. The two main outcomes for this study were 1) any telehealth (versus in-person), as well as 2) video-based care (versus telephone). For the ITS analysis, segmented logistic regression on repeated monthly observations of any telehealth and video-based care was used. Results Percent telehealth and video use increased from 13.9 to 63.1%, and 0.3 to 11.3%, respectively, before to after COVID-19 onset. According to adjusted percentages, GLA community-based clinics (37.7%, versus 29.8% in hospital-based clinics, p < .001), social workers/pharmacists/dietitians (53.7%, versus 34.0% for PC clinicians, p < .001), and minority groups, non-Hispanic African Americans (36.3%) and Hispanics (34.4%, versus 35.3% for Whites, p < .001) were more likely to use telephone than video. Conversely, mental health providers (43.3%) compared to PC clinicians (15.3%), and women (for all age groups, except 75+) compared to men, were more likely to use video than telephone (all p’s < .001). Conclusions Since telehealth care provision is likely to continue after COVID-19, additional research is needed to identify which PC outpatient services are better suited for telephone (e.g., case management) versus video-based care (e.g., integrated mental health visits). Additionally, it is important to understand how all clinics can systematically increase access to both telephone- and video-based PC services, while ensuring equitable care for all patient populations.

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Section: Discussionmentioning

confidence: 73%

Examining telehealth use among primary care patients, providers, and clinics during the COVID-19 pandemic

et al. 2022

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“… 24 Yet, despite technologies potential to support health and wellbeing of at-risk populations, there still remain challenges in maintaining connectivity to the internet, improving digital literacy, and establishing trust between patients and providers in this developing medium of health care delivery. 23 , 25 , 26 …”

Section: Discussionmentioning

confidence: 99%

Crossing the digital divide: a veteran affairs program to distribute video-enabled devices to patients in a supportive housing program

Wray

Campen

et al. 2022

JAMIA Open

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Objective Evaluate an initiative to distribute video-enabled tablets and cell phones to individuals enrolled in Veterans Health Affairs supportive housing program during the COVID-19 pandemic. Materials and Methods In September 2020, individuals in the Veteran Health Affairs (VA) Housing and Urban Development-VA Supportive Housing (HUD-VASH) program were offered either a video-enabled tablet or cellphone to support their communication and health care engagement needs. We examined sociodemographic and clinical characteristics of device recipients, and compared engagement in in-person, telephone, and video-based visits (categorized as primary care, specialty care, rehabilitation, HUD-VASH, mental health care, and other) for 6 months prior to (March 1, 2020–August 31, 2020) and following (September 1, 2020–July 30, 2021) device receipt. Results In total, 5127 Veterans received either a tablet (n = 4454) or a cellphone (n = 673). Compared to the 6 months prior to device receipt, in the 6 months following receipt, in-person and video engagement increased by an average of 1.4 visits (8%) and 3.4 visits (125%), respectively, while telephone engagement decreased (−5.2 visits; −27%). Both tablet and cellphone recipients had increased in-person visits (+1.3 visits [8%] and +2.1 visits [13%], respectively); while tablet users had a substantially larger increase in video-based engagement (+3.2 visits [+110%] vs. +0.9 [+64%]). Similar trends were noted across all assessed types of care. Discussion Providing video-enabled devices to Veterans in a supportive housing program may facilitate engagement in health care. Conclusions and Relevance VA’s device distribution program offers a model for expanding access to health-related technology and telemedicine to individuals in supportive housing programs.

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“…41,42 More research is needed to determine if, and under what circumstances, virtual care is effective for homeless adults. 43 The length and overall intensity of the intervention were also noted by patients and peers as a barrier to both satisfaction and implementation. Although designed to be an adjunct to primary care, there may be value in extending the intervention length to allow peers su cient time to support the complex needs of patients as well as assist them with developing personal health goals.…”

Section: Discussionmentioning

confidence: 99%

Peer Support and Whole Health Coaching to Address the Healthcare Needs of Homeless Veterans: A Pilot Study

Blonigen

Smelson

Smith

et al. 2022

Preprint

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Background: Homelessness is a robust social determinant of acute care service utilization among veterans. Although intensive outpatient programs have been developed for homeless veterans who are high utilizers of acute care (“super utilizers”), few scalable programs have been implemented to address their needs. Objective: Describe the development and pilot testing of a novel intervention that integrates the roles of a peer and whole health coach (“Peer-WHC”) in coordination with primary care teams to reduce homeless veterans’ frequent use of acute care. Design: Single-arm trial in three outpatient primary care clinics at a Veterans Health Administration (VHA) medical center; pre/post design using mixed-methods.Participants: Twenty veterans from VHA’s homeless registry who were super-utilizers of acute care and enrolled in primary care.Intervention: Weekly health coaching sessions with a peer over 12 weeks, including discussions of patients’ health care utilization patterns and coordination with primary care. Main Measures: Rates of session attendance and intervention fidelity, patient-reported satisfaction and changes in patient engagement and perceptions of health, pre/post utilization of acute and supportive care services, and qualitative interviews with multiple stakeholders to identify barriers and facilitators to implementation.Key Results: On average, patients attended 6.35 sessions (SD=3.5, Median=7). Satisfaction scores (M=28.75 out of 32; SD=2.79) exceeded a priori benchmarks. Patients’ perceptions of health improved from pre to post [t(df)=-2.26(14), p=0.04]. In the 3-months pre/post, 45% (n=9) and 15% (n=3) of patients, respectively, were hospitalized. Qualitative feedback from patients, providers, and peers and fidelity metrics suggested value in increasing the length of the intervention to facilitate goal-setting with patients and coordination with primary care. Conclusions: Findings support the feasibility, acceptability, and utility of Peer-WHC to address the healthcare needs of homeless veterans. A future trial is warranted to test the impact of Peer-WHC on reducing these patients’ frequent use of acute care.

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Use of Video Telehealth Tablets to Increase Access for Veterans Experiencing Homelessness

Cited by 45 publications

References 54 publications

Examining telehealth use among primary care patients, providers, and clinics during the COVID-19 pandemic

Examining telehealth use among primary care patients, providers, and clinics during the COVID-19 pandemic

Crossing the digital divide: a veteran affairs program to distribute video-enabled devices to patients in a supportive housing program

Peer Support and Whole Health Coaching to Address the Healthcare Needs of Homeless Veterans: A Pilot Study

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