Implementation and use of video tele-technologies in delivery of individualized community-based vocational rehabilitation services to rural veterans

2021 ◽  
pp. 1-19
Author(s):  
Zaccheus J. Ahonle ◽  
Consuelo M. Kreider ◽  
Jennifer. Hale-Gallardo ◽  
Gail. Castaneda ◽  
Kimberly. Findley ◽  
...  
Keyword(s):  
Vocational Rehabilitation ◽  
Rural Areas ◽  
Competitive Employment ◽  
Veterans Health ◽  
Health Administration ◽  
Structured Interviews ◽  
Community Based ◽  
Face To Face ◽  
Vocational Rehabilitation Services ◽  
Employment Rates

BACKGROUND: Telerehabilitation is an effective health delivery method for patients with a variety of health conditions. There is insufficient knowledge about use of telerehabilitation to support patients with disabilities and chronic illness in obtaining or sustaining competitive employment. Employment rates of Veterans are lower than civilian rates, and the employment gap is higher for Veterans living in rural areas. OBJECTIVE: To investigate factors that enabled and constrained routine use of video tele-technologies in delivering individualized community-based vocational rehabilitation (referred to as Tele-VR) services and to identify impacts and promising practices in implementation. METHODS: Semi-structured interviews with providers from two Veterans Health Administration Medical Sites that use telerehabilitation to supplement their existing face-to-face individualized community-based VR services. Interviews were analyzed using thematic analysis. RESULTS: Five themes in the implementation of Tele-VR were identified (1) Enhancing Workflow for Providers, (2) Improving Quality of Therapeutic Care, (3) Practicalities in Implementing Tele-VR, (4) Embedding Vocational Rehabilitation into Interdisciplinary Care as a Facilitator to Implementation, and (5) Impact of Tele-VR. CONCLUSIONS: The telerehabilitation delivery of employment service to Veterans with disabilities is a viable means for remotely providing or enhancing face-to-face individualized and community-based VR services that support Veterans’ competitive employment and job stability within their communities.

Using Remote Technology to Enhance Face-to-Face Community-Based Vocational Rehabilitation Services to Rural Veterans

2021 ◽  
Vol 102 (4) ◽  
pp. e3
Author(s):  
Zaccheus Ahonle ◽  
Consuelo Kreider ◽  
Jennifer Hale-Gallardo ◽  
Gail Castaneda ◽  
Kimberly Findley ◽  
...  
Keyword(s):  
Vocational Rehabilitation ◽  
Rehabilitation Services ◽  
Community Based ◽  
Face To Face ◽  
Vocational Rehabilitation Services

Using Remote Technology to Enhance Face-to-Face Community-Based Vocational Rehabilitation Services to Rural Veterans

2021 ◽  
Vol 102 (4) ◽  
pp. e18
Author(s):  
Zaccheus Ahonle ◽  
Consuelo Kreider ◽  
Jennifer Hale-Gallardo ◽  
Gail Castaneda ◽  
Kimberly Findley ◽  
...  
Keyword(s):  
Vocational Rehabilitation ◽  
Rehabilitation Services ◽  
Community Based ◽  
Face To Face ◽  
Vocational Rehabilitation Services

scholarly journals Telehealth Competencies for Interprofessional Teams Caring for Older Adults and Care Partners

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 796-796
Author(s):  
Becky Powers ◽  
Kathryn Nearing ◽  
Studi Dang ◽  
William Hung ◽  
Hillary Lum
Keyword(s):  
Older Adults ◽  
Best Practices ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Delivery Of Care ◽  
Face To Face ◽  
Evaluation Measures ◽  
Interprofessional Teams ◽  
Care Partners

Abstract Providing interprofessional geriatric care via telehealth is a unique clinical skillset that differs from providing face-to-face care. The lack of clear guidance on telehealth best practices for providing care to older adults and their care partners has created a systems-based practice educational gap. For several years, GRECC Connect has provided interprofessional telehealth visits to older adults, frequently training interprofessional learners in the process. Using our interprofessional telehealth expertise, the GRECC Connect Education Workgroup created telehealth competencies for the delivery of care to older adults and care partners for interprofessional learners. Competencies incorporate key telehealth, interprofessional and geriatric domains, and were informed by diverse stakeholders within the Veterans Health Administration. During this symposium, comments will be solicited from attendees. Once finalized, these competencies will drive the development of robust curricula and evaluation measures aimed at training the next generation of interprofessional providers to expertly care for older adults via telehealth.

scholarly journals Homeless on Main Street: Using Photovoice to Highlight Older Adults Among the Hidden Homeless

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 728-728
Author(s):  
H Shellae Versey
Keyword(s):  
Older Adults ◽  
Rural Areas ◽  
Meaning Making ◽  
Small Towns ◽  
Photo Elicitation ◽  
Service Agency ◽  
Structured Interviews ◽  
Community Based Interventions ◽  
Community Based ◽  
Formerly Homeless

Abstract Homelessness is a reality for a growing number of Americans living in small towns and rural areas. However, unlike in cities, housing instability may be less visible. Using a photo-elicitation method (i.e., Photovoice), this study explores the meaning of place and obscured visibility to currently and formerly homeless older adults living in a small town in central Connecticut. Participants (N = 27) were recruited from a local service agency, given cameras and asked to photograph areas around town that were meaningful to them. Photographs were developed and followed by in-person, semi-structured interviews with participants in which photos and experiences during the project were discussed. Primary themes included belonging, generativity, social isolation, and place-making as meaning-making. The study culminated in a community photography exhibition in which photographs from the project were displayed in public spaces around town. Implications for community-based interventions to reach homeless groups in rural areas are discussed. Part of a symposium sponsored by the Qualitative Research Interest Group.

Consumer perspectives of vocational rehabilitation and return to work following acquired brain injury

2021 ◽  
pp. 1-21
Author(s):  
Kerrin Watter ◽  
Areti Kennedy ◽  
Vanette McLennan ◽  
Jessica Vogler ◽  
Sarah Jeffery ◽  
...  
Keyword(s):  
Brain Injury ◽  
Return To Work ◽  
Vocational Rehabilitation ◽  
Acquired Brain Injury ◽  
System Level ◽  
Structured Interviews ◽  
Post Injury ◽  
Vocational Rehabilitation Services ◽  
Workplace Supports ◽  
Vocational Goals

Abstract Introduction: Following acquired brain injury, the goal of return to work is common. While return to work is supported through different rehabilitation models and services, access to vocational rehabilitation varies within and between countries, and global rates of employment post-injury remain low. The literature identifies outcomes from vocational programs and experiences with return to work, yet little is known about individuals’ perceptions and experiences regarding rehabilitation to support their vocational goals and experiences in attempting to return to work. Method: This qualitative study investigated the experiences of community-living adults with acquired brain injury (n = 8; mean age 45 years; mean time post-injury of 5.5 years) regarding their vocational rehabilitation and return to work. Focus groups and semi-structured interviews were conducted, with data analyzed via thematic analysis. Results: Participants identified negative and positive experiences with vocational rehabilitation and return to work. Five overarching themes were identified: addressing vocational rehabilitation in rehabilitation; facilitators of recovery and return to work; the importance and experience of working again; acquired brain injury and identity; and services, systems and policies. Participants also identified five key areas for early vocational rehabilitation services: education; service provision; employer liaison; workplace supports; and peer mentors. Study findings inform current and future practice and service delivery, at a clinical, service and system level.

scholarly journals IMPLEMENTING HOME SAFETY TOOLKIT TO CAREGIVERS OF VETERANS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S243-S243
Author(s):  
Scott A Trudeau
Keyword(s):  
Formative Evaluation ◽  
Veterans Health ◽  
Health Administration ◽  
Home Safety ◽  
Structured Interviews ◽  
Potential Benefits ◽  
Facilitators And Barriers ◽  
Key Staff ◽  
Type 3 ◽  
Selection Of

Abstract The purpose of this project was to study the processes necessary to make a Home Safety Toolkit (HST) for Veterans with dementia accessible to veterans and their caregivers. This Type 3 Implementation–Effectiveness Hybrid Research Design, included diagnostic analyses of the current processes by which Veterans receive home safety items, and identification of modifications necessary in order to provide the HST to Veterans with dementia. Two Veterans Health Administration Networks, one in the Northeast and one in the Mid-Atlantic region, participated. A formative evaluation used semi-structured interviews with key staff informants and caregivers identified facilitators and barriers to successful acquisition and use of home safety items. Qualitative data analysis reveals key barriers of time and cost, selection of best items, and caregiver reluctance to change. There was resounding support from caregivers regarding the potential benefits of self-paced toolkit including education and home safety items to implement for their veteran.

Abstract 137: Anticoagulation clinic provider’s perspective on management of patients on target specific oral anticoagulants: insights from the Veterans Affairs Health Care System

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Supriya Shore ◽  
P. Michael Ho ◽  
Anne Lambert-Kerzner ◽  
Fran Cunningham ◽  
Madeline McCarren ◽  
...  
Keyword(s):  
Side Effects ◽  
Patient Adherence ◽  
Comparative Method ◽  
Oral Anticoagulants ◽  
Anticoagulation Clinic ◽  
Veterans Health ◽  
Health Administration ◽  
Structured Interviews ◽  
High Performing

Background: Patients on target specific anticoagulants (TSOACs) such as dabigatran do not require routine laboratory testing and dose adjustment. In the Veterans Health Administration (VHA), anticoagulation clinics (ACCs) may elect to follow and manage patients on TSOACs, but whether it is needed or the optimal duration of follow-up is unknown. Our objective was to assess the perspective of anticoagulation clinic providers on follow-up care for dabigatran patients and to identify site-level practices associated with improved adherence to dabigatran. Methods: We ascertained ACC providers’ perspectives through semi-structured interviews by a single, trained internist. Purposive sampling was utilized to recruit senior ACC providers or supervisors at VHA sites with over 20 patients on dabigatran. We stratified sites into high and low performing sites based on whether sites had ≥ 75% of their patients adherent, based on a proportion-of-days-covered calculation. Data from the interviews was analyzed by 2 reviewers in an iterative process to identify recurrent and unifying themes. Constant comparative method of qualitative data analysis was used to identify best practices across various sites. Results: We interviewed ACC providers from 39 sites - including 18 providers at 16 high-performing sites and 25 providers at 23 low-performing sites. Follow-up practices for dabigatran varied across sites, with 6 sites not providing any follow-up, 14 sites following-up patients for less than 3 months, 9 sites following-up patients for 6 months, and 10 sites following-up patients indefinitely. During these follow-up visits, patients were contacted at regular intervals, mostly via telephone, by ACC providers to provide education, assess side-effects and adherence. Key strategies implemented at high-performing sites compared to low-performing sites included (1) examining adherence to other twice daily medications prior to approving dabigatran (2) education of patients by ACC providers prior to dabigatran initiation (3) continued telephone follow up by ACC staff despite no need for INR checks. Over a third of ACC providers expressed concerns regarding patient adherence to dabigatran. Most common reasons for this concern included its special storage requirements and high incidence of gastrointestinal side effects leading to high discontinuation rates. Conclusion: Dedicated follow-up of patients on dabigatran is associated with improved adherence. A multi-disciplinary approach involving anti-coagulation clinic providers to provide education and follow-up may be beneficial in management of TSOACs. Future work should compare the apparent benefit of this strategy with its non-trivial cost.

Assessment of patient satisfaction, financial, and environmental impacts of teleoncology.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 278-278
Author(s):  
Cindy Jiang ◽  
Garth William Strohbehn ◽  
Rachel Dedinsky ◽  
Shelby Raupp ◽  
Brittany Pannecouk ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Rural Areas ◽  
Financial Burden ◽  
Veterans Health ◽  
Health Administration ◽  
Secondary Effects ◽  
Medical Needs ◽  
Care Access ◽  
Strongly Agree

278 Background: There was rapid adoption of teleoncology at Veterans Health Administration (VHA) during the COVID-19 pandemic. One-third of 9 million VHA-enrolled Veterans live in rural areas. While digital solutions can expand capacity, enhance care access, and reduce financial burden, they may also exacerbate rural-urban health disparities. Careful evaluation of patients’ perceptions and policy tradeoffs are necessary to optimize teleoncology post-pandemic. Methods: Patients with ≥1 teleoncology visit with medical, surgical, or radiation oncology between March 2020 and June 2020 identified retrospectively. Validated, Likert-type survey assessing patient satisfaction developed. Follow-up survey conducted on patients with ≥1 teleoncology visit from August 2020 to January 2021. Travel distance, time, cost, and carbon dioxide (CO2) emissions calculated based on zip codes. Results: 100 surveys completed (response rate, 62%). Table with demographics. Patients overall satisfied with teleoncology (83% ‘Agree’ or ‘Strongly Agree’) but felt less satisfied than in-person visits (47% ‘Agree’ or ‘Strongly Agree’). Audiovisual component improved patient perception of involvement in care (two-sided, p = 0.0254), ability to self-manage health/medical needs (p = 0.0167), and comparability to in person visits (p = 0.0223). Follow-up survey demonstrated similar satisfaction. Total travel-related savings: 86,470 miles, 84,374 minutes, $49,720, and 35.5 metric tons of CO2. Conclusions: Veterans are broadly satisfied with teleoncology. Audiovisual capabilities are critical to satisfaction. This is challenging for rural populations with lack of technology access. Patients experienced financial and time savings, and society benefitted from reduced carbon emissions. Continued optimization needed to enhance patient experience and address secondary effects.[Table: see text]

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