Making Connections: Nationwide Implementation of Video Telehealth Tablets to Address Access Barriers in Veterans

Authors
Donna M Zulman
Emily P Wong
Cindie Slightam
Amy Gregory
Josephine C Jacobs
Rachel Kimerling
Daniel M Blonigen
John Peters
Leonie Heyworth
Journal Article
August 2019
JAMIA

Veterans frequently have complex medical, behavioral, and social needs, but often experience barriers in accessing health care services from the Department of Veterans Affairs (VA), the largest integrated health care system in the U.S. The most common barriers include transportation, cost, and geographic isolation in highly rural areas. Telehealth has increased access to VA care in recent years, but was limited to clinic-based video care. This study evaluates a national initiative to expand access to care for high-need VA patients through home-based tablet video technology.

More than 80 VA facilities around the country distributed tablets to nearly 6,800 patients in rural and geographically isolated locations. Four out of five recipients used the tablet in the study period, and recipients were more likely to use the tablet if they were older and had fewer chronic conditions, but still had complex medical and mental health needs. Some challenges for participating providers with tablet use included staffing shortages, insufficient training, lack of provider interest, and tablet connectivity issues. Some VA sites were able to overcome these challenges through sharing lessons and materials across sites and gaining leadership buy-in to allocate resources and increase provider engagement.

This evaluation demonstrates that use of tablets for a high-need population can help increase access to health care via an integrated health system, and is more relevant than ever during the coronavirus pandemic. Policies such as expanding access to high-quality broadband in rural areas may also address access to telehealth. 

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Population Addressed
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • What were some of the barriers to successful video telehealth use via tablets among high-need individuals, and how can an initiative overcome these barriers?
Level of Evidence
Moderate
What does this mean?