Gould Christine E, Paiko Lynsay, Carlson Chalise, Humber Marika Blair, Trivedi Ranak, Filips Julie, Savell A Denise, Lloyd Althea, Peeples Amanda D
Geriatric Research, Education and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, United States.
Department of Psychiatry and Behavioral Services, Stanford University School of Medicine, Palo Alto, CA, United States.
Front Health Serv. 2024 Nov 29;4:1221899. doi: 10.3389/frhs.2024.1221899. eCollection 2024.
Aging rural veterans have limited access to geriatric mental health services. The establishment of Veterans Health Administration (VHA) regional telehealth hubs, or Clinical Resource Hubs (CRHs), has the potential to improve access to specialist care via telehealth delivered across healthcare systems within each VHA region. We used the Consolidated Framework for Implementation Research (CFIR 1.0) to examine variations in the tele-geriatric mental health (tele-GMH) care models being used in four CRHs.
We interviewed 11 CRH geriatric mental health providers and 12 leaders to (1) characterize the models of care, (2) identify factors in their region that support tele-GMH, (3) identify factors underlying model adaptations, and (4) learn about barriers and facilitators during implementation. The interviews were analyzed using a combination of CFIR-based coding and rapid qualitative analysis.
The services used multiple telehealth modalities; their care delivery approach ranged from consultative to continuity services. Aspects of the inner setting, specifically structural characteristics, implementation climate, and implementation readiness, influenced the model that each CRH implemented. Barriers were largely related to inner setting structural characteristics. Facilitators highlighted the importance of planning, iteration, and engaging stakeholders during implementation.
Tele-GMH models varied in approach, tailoring their services to fit inner setting characteristics. Barriers and facilitators remained consistent across regions. Attending to inner setting characteristics, ongoing process improvement, and nurturing relationships with stakeholders is critical throughout the implementation of a tele-GMH program. Future research should examine the impact of the varied care delivery models on quantitative outcomes, including metrics related to access and healthcare utilization.
老龄化农村退伍军人获得老年心理健康服务的机会有限。退伍军人健康管理局（VHA）区域远程医疗中心，即临床资源中心（CRH）的设立，有可能通过在每个VHA区域内的医疗系统中提供远程医疗来改善专科护理的可及性。我们使用实施研究综合框架（CFIR 1.0）来研究四个CRH中使用的远程老年心理健康（tele-GMH）护理模式的差异。
我们采访了11名CRH老年心理健康提供者和12名负责人，以（1）描述护理模式，（2）确定其所在地区支持tele-GMH的因素，（3）确定模式调整的潜在因素，以及（4）了解实施过程中的障碍和促进因素。访谈采用基于CFIR的编码和快速定性分析相结合的方法进行分析。
这些服务使用了多种远程医疗方式；其护理提供方式从咨询服务到连续性服务不等。内部环境的各个方面，特别是结构特征、实施氛围和实施准备情况，影响了每个CRH实施的模式。障碍主要与内部环境的结构特征有关。促进因素强调了实施过程中规划、迭代和让利益相关者参与的重要性。
Tele-GMH模式在方法上各不相同，根据内部环境特征调整其服务。各地区的障碍和促进因素保持一致。在整个tele-GMH项目的实施过程中，关注内部环境特征、持续的过程改进以及与利益相关者建立良好关系至关重要。未来的研究应考察不同护理提供模式对定量结果的影响，包括与可及性和医疗利用相关的指标。
