Perceived Benefits of Geriatric Specialty Telemedicine among Rural Veterans and Caregivers

Veterans’ Perspectives highlights research conducted by HSR&D and/or QUERI investigators, showcasing the importance of research for Veterans – and the importance of Veterans for research.

In the January-February 2024 Issue:

• Introduction: Accessing healthcare services can be challenging—especially for those living in rural areas. Telemedicine can increase access to care, but there is limited research on the quality of geriatric specialty care delivered via telemedicine.
• The Study: In this study, researchers explored the quality of geriatric care provided to rural, older adults through VA's Office of Rural Health-funded GRECC Connect telemedicine program.
• Findings: Overall, Veterans and caregivers perceived that the content and benefits of GRECC Connect visits were well-aligned with the Geriatric 5Ms and Age-Friendly Health Systems models.
• Implications: Findings show that high-quality geriatric care can be delivered virtually, but additional work is needed to expand access to quality geriatric specialty telemedicine.

Introduction

While many people across the U.S. face challenges in accessing healthcare, this is particularly true for residents of rural areas.^[1] Telemedicine can increase access to care, but there is only limited research on the quality of geriatric care delivered via telemedicine. Models of comprehensive, high-quality geriatric care exist, but it remains unclear how these models translate to virtual care delivery. In addition, end-user perceptions of usefulness are critical in determining the value of geriatric specialty telemedicine.

The Study

In this study, researchers explored the extent to which high-quality geriatric care was provided to rural, older Veterans through VA's Office of Rural Health-funded GRECC Connect, VA’s geriatric telemedicine program that connects interdisciplinary teams from 15 hub sites in urban areas with older Veterans in rural areas. Researchers interviewed rural, older Veterans and their caregivers about the content and quality of their GRECC Connect telemedicine visits.

Study Participants

Researchers interviewed 30 geographically diverse rural Veterans and caregivers who participated in at least one GRECC Connect telemedicine visit between December 2020 and March 2021. Telemedicine visits were defined as having been conducted via VA Video Connect (VVC), at a community-based VA clinic using Clinical Video Telehealth (CVT), or over the phone between a remote geriatric medicine specialist and a Veteran at home. Participating Veterans were at least 65 years old and spoke English as their primary language. All Veterans were male, and 96% were white non-Hispanic. Caregivers were invited to join interviews, particularly in cases where Veterans were cognitively impaired. Questions focused on Veteran and caregiver perceptions of visit content; perceived benefits, challenges, and impacts related to the visit; satisfaction with the visit; and recommendations to improve the quality of the visit.

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*Falls, physical therapy, medication consultation after stroke, evaluation of sleep hygiene.

Findings

Visit Satisfaction

Overall, Veterans and caregivers perceived that the content and benefits of GRECC Connect visits were well-aligned with the Geriatric 5Ms and Age-Friendly Health Systems models of comprehensive, high-quality geriatric care. Many Veterans and caregivers were highly satisfied with GRECC Connect telemedicine, and said they would recommend GRECC Connect to other Veterans.

“I think the care is great. I mean, we’re very pleased with it. . . . [It’s] consistent care where it’s comfortable and [helps achieve] a good quality of life and that’s really what we’re wanting is the quality of life.”—Caregiver J

Some participants voiced dissatisfaction due to unmet expectations related to the purpose or the process of the visit. For example, one caregiver and Veteran were skeptical that an Alzheimer’s diagnosis could be determined based on “a few questions” conducted virtually. They worried that the visit’s purpose might be inappropriate for telemedicine.

“I thought maybe they would do more testing, asking questions [like], you know, ‘Remember this and remember that?’ and that did not happen. They just listened to what we had to say [and] then diagnosed him. . . . I just need to know how they came to this conclusion without any testing.”—Caregiver E

Benefits Associated with the Visit

Veterans and caregivers felt that the benefits of using GRECC Connect included improved Veteran health and increased knowledge, confidence, empowerment, support, and hope. This was the case even for those who were unable to participate in suggested activities or had yet to experience any improvement in their health.

“I think [my memory] is still pretty much the same. . . . I wasn’t able to do the exercise thing on the tablet or the computer; kind of everything stayed on the same plateau. [Still,] it gets me hopeful. I kind of look forward to improving. . . . Before, I [had] an ‘it is what it is’ type of an attitude, and now there’s hope.”—Patient A

Caregivers and Veterans felt supported when GRECC Connect clinicians shared information about additional resources, ordered needed items such as incontinence undergarments, and helped expedite referrals and coordinate care. One caregiver said this made them feel like “part of a team.”

“I don’t feel so alone now, and I think that he’s doing a little better.”—Caregiver E

Discussing experiences, concerns, and questions with GRECC Connect clinicians made Veterans and caregivers feel validated and cared for. Participants also felt assured that their experiences were normal and that they were doing things correctly.

“It really makes us both feel better. . . . It’s just helpful to know that somebody’s out there that cares.”—Caregiver B

Many Veterans and caregivers described experiences that illustrated how GRECC Connect visits aligned with the Geriatric 5Ms by addressing factors such as medications, mobility, mental and cognitive health, patient goals of care, and quality of life. For example, one Veteran reported that his GRECC Connect doctor encouraged him to spend more time with his granddaughters:

“I took that [encouragement] to heart and started doing some in-person things [with my granddaughters]—trying to do that more often.”—Patient B

Challenges Associated with the Visit

The most common critique of GRECC Connect visits among Veterans and caregivers focused on communication difficulties related to care coordination between GRECC Connect specialists and primary care—a problem not unique to GRECC Connect or telemedicine more generally. Other challenges noted by participants included difficulty accessing recommended programs and services, uncertainty related to instructions and follow-up, and not receiving as much information or treatment as desired.

“We’re not taking [the new medication prescribed from the GRECC Connect visit], and [the Veteran’s primary care provider] knows that. [The GRECC Connect clinician] does not know that because I don’t know if I’m supposed to stay in touch with her. It really wasn’t made clear to me, or maybe I just didn’t understand who I’m supposed to really talk to about [the Veteran] and this diagnosis.”—Caregiver E

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Implications

• Findings show that high-quality geriatric care can be delivered virtually.
• Additional work is needed to expand access to quality geriatric specialty telemedicine.
• The experience that GRECC Connect providers have gained is available to support the practice of others via recorded workshops, conference presentations, and toolkits.

Eileen Dryden, PhD (pictured), Lauren Moo, MD, and Camilla Pimentel, PhD, MPH, are investigators with HSR&D’s Center for Healthcare Organization & Implementation Research (CHOIR) in Bedford, MA.

This study was funded by VA's Office of Rural Health, Veteran Rural Health Resource Center in Salt Lake City.

Study Publication

Dryden EM, Kennedy MA, Conti J, Pimentel CB, et al. Perceived benefits of geriatric specialty telemedicine among rural patients and caregivers. Health Services Research. February 2023;58(S1): 26–35.

^[1] Exposing some important barriers to health care access in the rural USA - PubMed (nih.gov)

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