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Supporting Veterans, Caregivers, and Providers in Rural Regions with Tele-Geriatric Psychiatry Consultation: A Mixed Methods Pilot Study

Published:January 13, 2023DOI:https://doi.org/10.1016/j.jagp.2023.01.005

      Highlights

      • What is the primary question addressed by this study? This program evaluation aimed to characterize patients served and referring provider perceptions of a cross-facility tele-geriatric psychiatry consultation program.
      • What is the main finding of this study?— This approach is feasible, acceptable, and highly valued by referring providers. The program served older Veterans with complex psychiatric and cognitive needs across multiple care settings including outpatient and rehabilitation/long-term care.
      • What is the meaning of the finding?—Geriatric psychiatry consultation delivered to multiple VA medical systems via telehealth may increase access to this specialty in rural areas.

      Abstract

      Objectives

      Cross-facility tele-geriatric psychiatry consultation is a promising model for providing specialty services to regions lacking sufficient geriatric psychiatry expertise. This evaluation focused on assessing the feasibility and acceptability of a consultation program developed by a geriatric psychiatrist in a Veterans Health Administration regional telehealth hub.

      Design

      Concurrent, mixed methods program evaluation

      Setting

      A region served by a VA health care system telehealth hub

      Participants

      Patients with at least 1 geriatric mental health encounter with a geriatric psychiatrist consultant during a 1 year-period; referring providers.

      Intervention

      Virtual psychiatric evaluation of Veterans with time-limited follow-up and e-consultation with providers.

      Measurements

      Interviews with consultant, medical record data, and referring provider surveys

      Results

      315 Veterans (M = 76.0 ± 9.64 years; 40% rural-dwelling) had 666 encounters (M = 2.11 ± 1.78) with most occurring via clinical video telehealth (n = 443; 67.6%), e-consultation (n = 99; 15.1%), or video to home (n = 95; 14.5%). Most encounters were related to neurocognitive disorders, depressive disorders, trauma-related disorders, or serious mental illness. Referring providers (N = 58) highly recommended the program, reported high satisfaction, followed through with recommendations, and believed that this program increased access to geriatric psychiatry.

      Conclusions

      This single program was shown to be feasible, acceptable, and valued by the referring providers. The findings highlighted the complex presentations of Veterans referred, and the current unmet need of providers of such Veterans, providing impetus for wider implementation.

      Keywords

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