建立联系：在全国范围内推广视频远程医疗平板电脑以消除退伍军人获得医疗服务的障碍。
Making connections: nationwide implementation of video telehealth tablets to address access barriers in veterans.
作者信息
Zulman Donna M, Wong Emily P, Slightam Cindie, Gregory Amy, Jacobs Josephine C, Kimerling Rachel, Blonigen Daniel M, Peters John, Heyworth Leonie
机构信息
VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA.
Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA.
出版信息
JAMIA Open. 2019 Aug 5;2(3):323-329. doi: 10.1093/jamiaopen/ooz024. eCollection 2019 Oct.
BACKGROUND
Video telehealth technology has the potential to enhance access for patients with clinical, social, and geographic barriers to care. We evaluated the implementation of a US Department of Veterans Affairs (VA) initiative to distribute tablets to high-need Veterans with access barriers.
METHODS
In this mixed methods implementation study, we examined tablet adoption (ie, facility-level tablet distribution rates and patient-level tablet utilization rates) and reach (ie, sociodemographic and clinical characteristics of tablet recipients) between 5/1/16 and 9/30/17. Concurrently, we surveyed 68 facility telehealth coordinators to determine the most common implementation barriers and facilitators, and then conducted interviews with telehealth coordinators and regional leadership to identify strategies that facilitated tablet distribution and use.
RESULTS
86 VA facilities spanning all 18 geographic regions, distributed tablets to 6 745 patients. Recipients had an average age of 56 years, 53% lived in rural areas, 75% had a diagnosed mental illness, and they had a mean (SD) of 5 (3) chronic conditions. Approximately 4 in 5 tablet recipients used the tablet during the evaluation period. In multivariate logistic regression, tablet recipients were more likely to use their tablets if they were older and had fewer chronic conditions. Implementation barriers included insufficient training, staffing shortages, and provider disinterest (described as barriers by 59%, 55%, and 33% of respondents, respectively). Site readiness assessments, local champions, licensure modifications, and use of mandates and incentives were identified as strategies that may influence widespread implementation of home-based video telehealth.
CONCLUSION
VA's initiative to distribute video telehealth tablets to high-need patients appears to have successfully reached individuals with social and clinical access barriers. Implementation strategies that address staffing constraints and provider engagement may enhance the impact of such efforts.
背景
视频远程医疗技术有潜力改善那些面临临床、社会和地理就医障碍的患者获得医疗服务的机会。我们评估了美国退伍军人事务部（VA）一项向有就医障碍的高需求退伍军人分发平板电脑的倡议的实施情况。
方法
在这项混合方法实施研究中，我们考察了2016年5月1日至2017年9月30日期间平板电脑的采用情况（即机构层面的平板电脑分发率和患者层面的平板电脑使用率）及覆盖范围（即平板电脑接收者的社会人口统计学和临床特征）。同时，我们对68名机构远程医疗协调员进行了调查，以确定最常见的实施障碍和促进因素，然后对远程医疗协调员和地区领导进行访谈，以确定有助于平板电脑分发和使用的策略。
结果
横跨所有18个地理区域的86个VA机构向6745名患者分发了平板电脑。接收者的平均年龄为56岁，53%居住在农村地区，7%患有确诊的精神疾病，他们平均有5（3）种慢性病。在评估期间，约五分之四的平板电脑接收者使用了平板电脑。在多变量逻辑回归分析中，年龄较大且慢性病较少的平板电脑接收者更有可能使用他们的平板电脑。实施障碍包括培训不足、人员短缺和提供者缺乏兴趣（分别有59%、55%和33%的受访者将其描述为障碍）。现场准备评估、当地倡导者、执照修改以及使用强制规定和激励措施被确定为可能影响基于家庭的视频远程医疗广泛实施的策略。
结论
VA向高需求患者分发视频远程医疗平板电脑的倡议似乎成功覆盖了那些面临社会和临床就医障碍的个人。解决人员配备限制和提供者参与度的实施策略可能会增强此类努力的影响。
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