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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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1050 — Accessing Telehealth through Local Area Stations (ATLAS)— the Veteran Perspective

Lead/Presenter: Marcie Lee,  COIN - Seattle/Denver
All Authors: Lee M (Denver COIN, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA), Stevenson, L (VA Northeast Ohio Healthcare System, Cleveland, OH, USA) Barnard, J (Denver COIN, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA) Kenney R, R (Denver COIN, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA) Miller, E (Denver COIN, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA) Sayre, G (Seattle COIN, University of Washington, Seattle, WA)

Objectives:
Accessing Telehealth through Local Area Stations (ATLAS) was established in FY19 to enhance the accessibility of VA health care by establishing private telehealth locations in the communities Veterans reside in. Partnerships were formed with Veteran Service Organizations (i.e. VFW, AL) and Walmart with the assistance of commercial partnerships to design ATLAS sites. Our goal was to assess implementation of ATLAS by exploring Veterans’ experience receiving care at either an ATLAS site or through community care.

Methods:
To assess the implementation of ATLAS, semi-structured interviews were conducted with 29 Veterans who received care through ATLAS (across 4 ATLAS sites) and 21 Veterans who opted to use community care across six ATLAS catchment areas. Interviews were conducted between May 2020 and May 2022 via telephone. Audio recordings were transcribed verbatim and analyzed in ATLAS.ti9. Deductive and inductive content analysis was conducted to identify themes including experience with ATLAS or community care, benefits of ATLAS, barriers to use, comfort with telehealth, and recommendations for improvement.

Results:
ATLAS Veterans revealed that ATLAS was easy to utilize, and the presence of an attendant to trouble shoot issues was helpful. The rooms were clean, comfortable, and had enough room for Veterans in wheelchairs, service animals, or caregivers. The audio capabilities and large screen made ATLAS attractive for veterans with hearing, vision, and mobility issues. Some barriers for ATLAS patients were the limited services and time slots for appointments, technology issues, and constraints of telehealth appointments (e.g., inability to do physical exams, draw blood, or obtain medications onsite). Privacy and confidentiality were concerns for Veterans but most reported feeling comfortable in the designed space at VSOs. Walmart sites were less popular; Veterans expressed a lack of trust and privacy concerns. Community care Veterans agreed that ATLAS would be a great addition for their community, but many admitted that they would not use it. Veterans chose not to use ATLAS primarily due to established care and relationships with community care doctors. Additionally, they could use dual insurance when visits weren’t covered by the VA, had access to local labs and other specialists, or were generally more satisfied with community care.

Implications:
Veterans feel comfortable using ATLAS to connect with VA providers and offered suggestions for improvement that include, expansion of services offered at ATLAS locations and access to labs and medications locally. However, having ATLAS closer to Veterans does not guarantee that Veterans will use the service. Factors that impact health access in rural communities (e.g access to specialty care, continuity of care, travel, etc.) influence the decisions of Veterans to use ATLAS. These findings suggest that when designing and evaluating new initiatives, it is important to examine how Veterans chose what kind of care options to use and to consider ways to address those needs.

Impacts:
These findings provide critical insights Veterans experience that can inform and improve on ongoing ATLAS implementation efforts to fulfill the MISSION Act’s goal of “Anywhere to Anywhere” telehealth legislation and provide veterans access to VA healthcare in a private secure space in their own community.