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Supporting Veterans, Caregivers, and Providers in Rural Regions With Tele-Geriatric Psychiatry Consultation: A Mixed
Christine E Gould1, Chalise Carlson2, Ana Jessica Alfaro1
1VA Palo Alto Health Care System, Geriatric Research (CEG, CC, AJA, PSM), Education and Clinical Center (GRECC), Palo Alto, CA; Department of Psychiatry and Behavioral Services (CEG, AJA, RT), Stanford University School of Medicine, Palo Alto, CA.
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:
Three hundred fifteen 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.
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