VA Geriatric Scholar Jessica Alva was a neuropsychologist at Central Virginia VA when her clinic quickly shifted to telehealth during the pandemic. With this change she noticed a large discrepancy among older Veterans’ use of VA Video Connect (VVC) compared to other age groups.
“Seventy-five percent of our older Veterans were unable to complete a telehealth visit due to a lack of equipment or low technology literacy,” said Alva.
Motivated by her recent training with the VA Geriatric Scholars Program, she launched a quality improvement project to help older Veterans reap the benefits of VA Video Connect. She collaborated with providers from the Central Virginia VA Geriatric Evaluation Clinic, a specialty team that is dedicated to comprehensive assessments of older Veterans with multiple medical and functional problems with the goal of optimizing health and daily function.
Proactively helping Veterans prepare for their telehealth visit
Alva’s team identified a major roadblock hindering the success of telehealth visits with VVC was that problems with technology or connectivity were not known until the actual telehealth appointment time, potentially leading to delays in needed health care.
The team decided they could solve most issues proactively by gathering key information while engaging with the patient at two different time points. First, to assess if it was feasible for the older Veteran to engage in a telehealth visit, then to see if they were ready for that visit.
The information gathered determined specific needs the team could address. If the Veteran didn’t have a video-capable device, they arranged for the delivery of an iPad. If the Veteran had a device but was new to VA Video Connect, the team coordinated a test call to practice.
100% of older patients’ telehealth visits were successful
“It wasn’t a matter of figuring out how to address the barriers. It was a matter of identifying the main barriers in the first place,” said Alva. “Asking these focused questions allowed the team to quickly identify any potential problems and have enough time address them prior to the appointment.”
In just over two months, Veterans’ use of telehealth jumped to 47% from 29%. And 100% of scheduled telehealth appointments were completed successfully compared to 56% at the start of the project.
“Working as a team was critical in being able to make these positive changes. That combined effort makes change possible,” she added.
VA telehealth model of care benefits patients and providers
Dr. Alva’s neuropsychology and telehealth expertise unlocked new opportunities at VA. She recently joined the Veterans’ Cognitive Assessment and Management Program, or V-CAMP, at Greater Los Angeles VA. The V-CAMP team employs telehealth to increase access to cognitive evaluation, medication consultation, and care management for older Veterans in rural communities where access to dementia specialists is limited.
“V-CAMP serves Veterans who live hundreds of miles away, Veterans who might not be able to travel to the main VA Medical Center for a face-to-face appointment,” said Alva. She will remain in Virginia, now as a full-time remote neuropsychologist serving rural Veterans enrolled with Greater Los Angeles VA—evidence of the flexibility the VA telehealth model of care offers to patients and providers.
“It’s a perfect fit,” she said.