Dr. Interian and Dr. King are with Mental Health and Behavioral Sciences, U.S. Department of Veterans Affairs (VA) New Jersey Health Care System, Lyons, New Jersey. Dr. Interian is also with the Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey. Ms. St. Hill is with the Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey. Ms. Robinson and Ms. Damschroder are with the Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
Psychiatr Serv. 2018 Jan 1;69(1):69-75. doi: 10.1176/appi.ps.201700004. Epub 2017 Sep 1.
The Veterans Health Administration (VHA) has recently implemented video-to-home (V2H) telehealth as part of a strategy to improve access to mental health treatment. Implementation research of this modality is needed, given that V2H telehealth transforms the traditional face-to-face delivery of mental health services. To address this need, V2H implementation was evaluated by examining barriers and facilitators that were associated with level of staff V2H experience and factors that differentiated facilities with various levels of V2H performance.
Semistructured interviews with VHA personnel (N=33) from three facilities were conducted. The facilities were selected by overall number of mental health V2H visits during fiscal year (FY) 2015 as well as by growth in number of visits from FY 2014 through FY 2015. Factors influencing implementation were identified through qualitative analyses that contrasted responses by groups of participants with three different levels of V2H experience (no experience, limited experience, most experience) as well as three facilities that differed in V2H productivity (high visit count, high visit growth, and low visit count and low visit growth).
Providers seemed to encounter different barriers and facilitators depending on their level of experience with V2H. Site-level analyses illustrated the importance of logistical support, especially for providers who are newly adopting the technology. Other factors that differentiated the facilities were also identified and described.
Key factors related to implementation of V2H telehealth pertained to provider buy-in and logistical support. Facility-level strategies that address these factors may enhance provider progression from nonuse to sustained use.
退伍军人健康管理局（VHA）最近实施了视频到家庭（V2H）远程医疗，作为改善心理健康治疗服务获取途径的一项策略。鉴于 V2H 远程医疗改变了传统的面对面心理健康服务提供方式，需要对这种模式进行实施研究。为了解决这一需求，通过检查与员工 V2H 经验水平相关的障碍和促进因素，以及区分具有不同 V2H 绩效水平的设施的因素，对 V2H 的实施进行了评估。
对来自三个设施的 33 名 VHA 人员进行了半结构化访谈。这些设施是根据 2015 财年（FY）心理健康 V2H 访问总数以及从 2014 财年到 2015 财年访问次数的增长情况选择的。通过对具有不同 V2H 经验水平（无经验、有限经验、最有经验）的三组参与者的反应进行对比，以及对 V2H 生产力不同的三个设施（访问量高、访问量增长快和访问量低且增长慢）进行对比，通过定性分析确定了影响实施的因素。
根据 V2H 经验水平，提供者似乎遇到了不同的障碍和促进因素。现场分析说明了后勤支持的重要性，尤其是对于新采用该技术的提供者而言。还确定并描述了区分这些设施的其他因素。
与 V2H 远程医疗实施相关的关键因素涉及提供者的认可和后勤支持。解决这些因素的设施层面策略可能会促进提供者从不使用到持续使用的转变。
