Veterans with chronic health issues, such as high blood pressure, are not strangers to routine monitoring. At times, this may require challenging or inconvenient travel for in-person clinical care.
Veteran blood pressure readings taken at a provider’s office may be elevated compared with other settings. This is known as “white coat syndrome” and can result in an abnormal reading.
If a Veteran has an abnormal reading during their visit, the current standard requires them to return to the clinic for a follow-up evaluation. But Veterans may be unable or unwilling to return in person, so they may not receive the necessary follow-up assessment.
Video blood pressure visits
In January 2018, Dr. Margaret Carrico and registered nurse Cortney Frosch identified an opportunity to make these follow-up appointments more accessible for Veterans.
A Veteran in need of a follow-up evaluation is issued a blood pressure cuff and instructions on how to use VA Video Connect, VA’s secure videoconferencing app. The Veteran can join a video visit from their home or location of choice using the app and an internet-connected, video-capable device.
During the visit, the Veteran uses the cuff and shows the displayed reading in front of the camera for their VA provider to document. Veterans can also learn how to properly use a blood pressure cuff over a video appointment.
As with an in-person visit, the provider then evaluates the need for any changes to the care plan, enters the blood pressure measurements into the Veteran’s medical record and completes the encounter.
Avoiding risk of exposure and saving travel time
By improving access to care, the Video Blood Pressure Visits program also improves patient outcomes. Veterans are more likely to receive follow-up care because VA video visits save Veterans the risk of exposure to infectious diseases, the time and cost of travel and childcare and time off work. There is no copay for a video visit into a Veteran’s home.
Veterans are more likely to receive follow-up care because of VA video blood pressure visits
“Video blood pressure visits are a great introduction to virtual care,” said Frosch. “Clinicians start to visualize all the potential uses for virtual care once they try a simple VA video blood pressure visit and see how easy and effective video visits can be.”
The Video Blood Pressure Visits program is a three-year VA enterprise-wide initiative and a national VHA Shark Tank Competition winner. The program, funded by the Office of Rural Health, offers a video visit option to the in-person blood pressure follow-up evaluation.
One Video Connect can lead to many others
The Video Blood Pressure Visits help implement a Video Blood Pressure Visits program at a facility but is also a nurse-led intervention. The program builds the foundation for VA care teams to adopt video visits more widely.
“If you have a VA Video Connect visit in one area of the medical center and you have engaged a Veteran to do them, you have opened up the possibility to have video visits in so many other areas,” registered nurse Kathy Craig said.
Craig leads the Video Blood Pressure Visits program with fellow program facilitators registered nurse Andrea Kossoudji and health systems specialist Lisa Huang. The program is overseen by Dr. Maia Carter through the Office of Primary Care’s Virtual Care Integration efforts.
Before and after each eight-session cohort, the program team meets with facility leadership to explore how they can support the use of VA Video Connect at their location.
The cohort’s team approach engages providers at all levels. “Not only do we train front-line staff, mainly nurses, but all of those up the clinical ladder,” said Kossoudji.
Course evaluations show that nurses felt more competent and confident to train other nurses, VA staff members and Veterans. “We see the Video Blood Pressure Visits program helping VA staff,” said Huang. “Of course, it’s about the Veteran and the Veteran outcome. But it’s also about who’s driving that outcome.”
Life changing program for many Veterans
Veteran Theodore Dix said that despite his age, VA Video Connect enabled him to receive VA care while remaining safe at home during the pandemic. “I am 76,” said Dix. “I have four conditions that put me at risk for COVID-19. And one of my doctors told me I was a ‘walking, living target for the virus.’ Without VA Video Connect, I would have been endangered at the hospital for an appointment.”
“We know that, for a lot of Veterans, this has really been life-changing for them to still be able to connect with their VA care teams,” said Kossoudji.
VA video visits have increased by more than 1,800% since the COVID-19 pandemic began in March 2020. In fiscal 2021, more than 2 million Veterans took part in over 9.5 million video visits, of which over 32,000 were video blood pressure visits.
Successful program adoptions
Pilot program results show that 87% of Veterans prefer video blood pressure visits to in-person follow-ups at the clinic.
“It’s really opened up the doors for not just younger Veterans that are in the working field and can’t miss work but also those Veterans that may not have been able to connect with their provider otherwise,” Kossoudji said. “It really provides a different experience — not only for the Veteran but also for the clinician who’s able to capture more to enhance the clinical assessment and experience overall.”
To learn more, check out the Video Blood Pressure Visits page.