A Roadmap for Implementing Virtual Geriatric Mental Health Services for Rural Veterans: Qualitative Longitudinal...

Access to geriatric mental health (GMH) care is limited in rural areas. To meet this need, the Veterans Health Administration provides specialty tele-GMH care for aging rural veterans via regional telehealth hubs.

This study aims to create a roadmap describing key phases and determinants underlying the implementation and sustainment of tele-GMH services as part of a qualitative longitudinal evaluation of tele-GMH teams.

Semistructured interviews were conducted with clinicians from all 8 tele-GMH teams (n=25) at 3 time points across a 3-year period (October 2021-September 2024). Interview (n=46) data were summarized into key domains using a templated rapid qualitative approach, guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Further thematic analysis and team discussion elucidated the findings.

We identified key activities and determinants of success in three phases: (1) preimplementation (engaging leaders, securing funding/hiring, and defining services); (2) implementation scale-up and expansion (advertising, addressing challenges, seeking feedback, refining, and growth); and (3) sustainment (maintenance). Activities within each phase were cyclical and iterative (ie, nonlinear). Barriers to implementation included unfamiliarity with local aging resources; facilitators included tailoring strategies and engaging referring clinicians.

Similar processes emerged across regions in the development and sustainment of tele-GMH services, allowing for the creation of a unified roadmap. Limitations including sampling bias are discussed. Further work could apply and evaluate the utility of the roadmap to guide creation of tele-GMH services in new regions to enhance access to specialty care for aging rural veterans.