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

Published:January 13, 2023DOI:


      • 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.



      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.


      Concurrent, mixed methods program evaluation


      A region served by a VA health care system telehealth hub


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


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


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


      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.


      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.


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      1. National Center for Veterans Analysis and Statistics. Veteran Population. February 21, 2022. Available at

        • Karel MJ
        • Wray LO
        • Adler G
        Mental Health Needs of Aging Veterans: Recent Evidence and Clinical Recommendations.
        Clin Gerontol. 2022; 45: 252-271
        • Hoge MA
        • Karel MJ
        • Zeiss AM
        Strengthening psychology's workforce for older adults: Implications of the Institute of Medicine's report to Congress.
        Am Psychol. 2015; 70: 265-278
        • Moye J
        • Karel MJ
        • Stamm KE
        Workforce analysis of psychological practice with older adults: Growing crisis requires urgent action.
        Train Educ Prof Psychol. 2019; 13: 46-55
        • Juul D
        • Colenda CC
        • Lyness JM
        Subspecialty Training and Certification in Geriatric Psychiatry: A 25-Year Overview.
        Am J Geriatr Psychiatry. 2017; 25: 445-453
        • Kearney LK
        • Post EP
        • Pomerantz AS
        Applying the interprofessional patient aligned care team in the Department of Veterans Affairs: Transforming primary care.
        Am Psychol. 2014; 69: 399-408
        • Karlin BE
        • Karel MJ
        National Integration of Mental Health Providers in VA Home-Based Primary Care: An Innovative Model for Mental Health Care Delivery With Older Adults.
        The Gerontologist. 2014; 54 (Edited by Meeks S): 868-879
        • Agapoff JR
        • Maixner S
        • Takeshita J
        A Survey of Geriatric Psychiatry Fellows and Program Directors: Specialty Choice.
        Program Choice, and Program Quality Acad Psychiatry. 2022; 46: 455-459
        • Institute of Medicine
        The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?.
        The National Academies Press, Washington, DC2012 (Available at)
      2. Cowper Ripley D, Ahern J, Litt E, Rural Veterans Health Care Atlas, 2nd edition FY2015. Department of Veterans Affairs, Washington, D.C.

        • Hicken B
        • Parry K
        Supporting older military veterans in the rural US.
        Qual Ageing Older Adults. 2018; 19: 286-297
        • Teich J
        • Ali MM
        • Lynch S
        Utilization of Mental Health Services by Veterans Living in Rural Areas: Mental Health Service Use by Rural Veterans.
        J Rural Health. 2017; 33: 297-304
        • Gentry MT
        • Lapid MI
        • Rummans TA
        Geriatric Telepsychiatry: Systematic Review and Policy Considerations.
        Am J Geriatr Psychiatry. 2019; 27: 109-127
        • Hantke N
        • Lajoy M
        • Gould CE
        Patient Satisfaction With Geriatric Psychiatry Services via Video Teleconference.
        Am J Geriatr Psychiatry. 2020; 28: 491-494
      3. Nkodo J-A, Gana W, Debacq C, The Role of Telemedicine in the Management of the Behavioral and Psychological Symptoms of Dementia: A Systematic Review Am J Geriatr Psychiatry February 2022:S1064748122000276.

        • Lum HD
        • Nearing K
        • Pimentel CB
        Anywhere to Anywhere: Use of Telehealth to Increase Health Care Access for Older, Rural Veterans.
        Public Policy Aging Rep. 2020; 30 (Edited by Kaskie B): 12-18
        • Srinivasan S
        Bridging the Gap: Geriatric Telepsychiatry Consultations to a Rural PACE Program.
        J Technol Behav Sci. 2017; 2: 77-83
        • McBain RK
        • Sousa JL
        • Rose AJ
        Impact of Project ECHO Models of Medical Tele-Education: a.
        Systematic Review J Gen Intern Med. 2019; 34: 2842-2857
      4. Guzman-Clark J, Harrell K, Leff A, Implementation of an ECHO-Based Program to Provide Geriatric Specialty Care Consultation and Education to Remote Primary Care Teams Fed Pract 2016; 33:40-45.

      5. Creswell JW, Plano Clark VL: Designing and Conducting Mixed Methods Research, (3rd edition). Los Angeles, CA, Sage Publishing 2018.

      6. USDA ERS - Rural-Urban Commuting Area Codes, Available at Accessed August 17, 2022.

      7. Fihn S: Care Assessment Need (CAN) Score and the Patient Care Assessment System (PCAS): Tools for Care Management:66.

      8. Burningham Z, Leng J, Peters CB, Predicting Psychiatric Hospitalizations among Elderly Veterans with a History of Mental Health Disease EGEMs Gener Evid Methods Improve Patient Outcomes 2018; 6:7.

      9. Clinical Classifications Software Refined (CCSR), Available at Accessed May 17, 2022.

        • Vaismoradi M
        • Turunen H
        • Bondas T
        Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study: Qualitative descriptive study.
        Nurs Health Sci. 2013; 15: 398-405
        • Guest G
        • MacQueen KM
        • Namey EE
        Applied thematic analysis.
        Sage Publications, Los Angeles, CA2012
        • Vaismoradi M
        • Jones J
        • Turunen H
        Theme development in qualitative content analysis and thematic analysis.
        J Nurs Educ Pract. 2016; 6: p100
        • Hilty DM
        • Torous J
        • Parish MB
        A Literature Review Comparing Clinicians’ Approaches and Skills to In-Person, Synchronous, and Asynchronous Care: Moving Toward Competencies to Ensure Quality Care.
        Telemed E-Health. 2021; 27: 356-373
        • Lee M
        • Leonard C
        • Greene P
        Perspectives of VA Primary Care Clinicians Toward Electronic Consultation-Related Workload Burden: A Qualitative Analysis.
        JAMA Netw Open. 2020; 3e2018104