Gould Christine E, Carlson Chalise, Alfaro Ana Jessica, Trivedi Ranak, Savell A Denise, Mehta Priyanka S, Burningham Zachary, Peeples Amanda, Filips Julie
VA Palo Alto Health Care System, Geriatric Research (CEG, CC, AJA, PSM), Education and Clinical Center (GRECC), Palo Alto, CA; Department of Psychiatry and Behavioral Services (CEG, AJA, RT), Stanford University School of Medicine, Palo Alto, CA.
VA Palo Alto Health Care System, Geriatric Research (CEG, CC, AJA, PSM), Education and Clinical Center (GRECC), Palo Alto, CA.
Am J Geriatr Psychiatry. 2023 Apr;31(4):279-290. doi: 10.1016/j.jagp.2023.01.005. Epub 2023 Jan 14.
Cross-facility tele-geriatric psychiatry consultation is a promising model for providing specialty services to regions lacking sufficient geriatric psychiatry expertise. This evaluation focused on assessing the feasibility and acceptability of a consultation program developed by a geriatric psychiatrist in a Veterans Health Administration regional telehealth hub.
Concurrent, mixed methods program evaluation.
A region served by a VA health care system telehealth hub.
Patients with at least 1 geriatric mental health encounter with a geriatric psychiatrist consultant during a 1 year-period; referring providers.
Virtual psychiatric evaluation of Veterans with time-limited follow-up and e-consultation with providers.
Interviews with consultant, medical record data, and referring provider surveys.
Three hundred fifteen Veterans (M = 76.0 ± 9.64 years; 40% rural-dwelling) had 666 encounters (M = 2.11 ± 1.78) with most occurring via clinical video telehealth (n = 443; 67.6%), e-consultation (n = 99; 15.1%), or video to home (n = 95; 14.5%). Most encounters were related to neurocognitive disorders, depressive disorders, trauma-related disorders, or serious mental illness. Referring providers (N = 58) highly recommended the program, reported high satisfaction, followed through with recommendations, and believed that this program increased access to geriatric psychiatry.
This single program was shown to be feasible, acceptable, and valued by the referring providers. The findings highlighted the complex presentations of Veterans referred, and the current unmet need of providers of such Veterans, providing impetus for wider implementation.
跨机构远程老年精神病学咨询是一种很有前景的模式，可为缺乏足够老年精神病学专业知识的地区提供专科服务。本评估聚焦于评估由一名老年精神病医生在退伍军人健康管理局区域远程医疗中心开发的咨询项目的可行性和可接受性。
同步混合方法项目评估。
由退伍军人事务部医疗保健系统远程医疗中心服务的一个地区。
在1年期间至少与一名老年精神病学顾问有过1次老年心理健康诊疗接触的患者；转诊提供者。
对退伍军人进行虚拟精神病学评估，并进行限时随访以及与提供者进行电子咨询。
对顾问进行访谈、病历数据以及转诊提供者调查。
315名退伍军人（年龄M = 76.0 ± 9.64岁；40%居住在农村）有666次诊疗接触（M = 2.11 ± 1.78），大多数通过临床视频远程医疗进行（n = 443；67.6%）、电子咨询（n = 99；15.1%）或视频到家（n = 95；14.5%）。大多数诊疗接触与神经认知障碍、抑郁障碍、创伤相关障碍或严重精神疾病有关。转诊提供者（N = 58）高度推荐该项目，报告满意度高，遵循了建议，并认为该项目增加了获得老年精神病学服务的机会。
该单一项目被证明是可行的、可接受的，并且受到转诊提供者的重视。研究结果突出了被转诊退伍军人的复杂病情表现，以及此类退伍军人的提供者目前未得到满足的需求，为更广泛的实施提供了动力。
