Original Research

GRECC Connect: Geriatrics Telehealth to Empower Health Care Providers and Improve Management of Older Veterans in Rural Communities

Fed Pract. 2019 October;36(10):464-470

References

1. US Department of Veterans Affairs. Office of Rural Health Annual report: Thrive 2016. https://www.ruralhealth.va.gov/docs/ORH2016Thrive508_FINAL.pdf. Accessed September 10, 2019.

2. Holder KA. Veterans in Rural America: 2011–2015. US Census Bureau: Washington, DC; 2016. American Community Survey Reports, ACS-36.

3. US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce, National Center for Health Workforce Analysis.2017. National and regional projections of supply and demand for geriatricians: 2013-2025. https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/GeriatricsReport51817.pdf. Published April 2017. Accessed September 10, 2019.

4. Peterson L, Bazemore A, Bragg E, Xierali I, Warshaw GA. Rural–urban distribution of the U.S. geriatrics physician workforce. J Am Geriatr Soc. 2011;59(4):699-703.

5. Lindeman D. Interview: lessons from a leader in telehealth diffusion: a conversation with Adam Darkins of the Veterans Health Administration. Ageing Int. 2010;36(1):146-154.

6. Darkins A, Foster L, Anderson C, Goldschmidt L, Selvin G. The design, implementation, and operational management of a comprehensive quality management program to support national telehealth networks. Telemed J E Health. 2013;19(7):557-564.

7. US Department of Veterans Affairs. Clinical video telehealth into the home (CVTHM)toolkit for providers. https://www.mirecc.va.gov/visn16//docs/CVTHM_Toolkit.pdf. Accessed September 10, 2019.

8. Darkins A. Telehealth services in the United States Department of Veterans Affairs (VA). https://myvitalz.com/wp-content/uploads/2016/07/Telehealth-Services-in-the-United-States.pdf. Published July 2016. Accessed September 10, 2019.

9. US Department of Veterans Affairs. VA announces telemental health clinical resource centers during telemedicine association gathering [press release]. https://www.va.gov/opa/pressrel/includes/viewPDF.cfm?id=2789. Published May 16, 2016. Accessed September 10, 2019.

10. Hung WW, Rossi M, Thielke S, et al. A multisite geriatric education program for rural providers in the Veteran Health Care System (GRECC Connect). Gerontol Geriatr Educ. 2014;35(1):23-40.

11. Kramer BJ. The VA geriatric scholars program. Fed Pract. 2015;32(5):46-48.

12. Kramer BJ, Creekmur B, Howe JL, et al. Veterans Affairs Geriatric Scholars Program: enhancing existing primary care clinician skills in caring for older veterans. J Am Geriatr Soc. 2016;64(11):2343-2348.

13. Powers BB, Homer MC, Morone N, Edmonds N, Rossi MI. Creation of an interprofessional teledementia clinic for rural veterans: preliminary data. J Am Geriatr Soc. 2017;65(5):1092-1099.

14. Wright SM, Hedin SC, McConnell M, et al. Using shared decision-making to address possible overtreatment in patients at high risk for hypoglycemia: the Veterans Health Administration’s Choosing Wisely Hypoglycemia Safety Initiative. Clin Diabetes. 2018;36(2):120-127.

15. Chang W, Homer M, Rossi MI. Use of clinical video telehealth as a tool for optimizing medications for rural older veterans with dementia. Geriatrics (Basel). 2018;3(3):pii E44.

16. US Department of Veterans Affairs, Office of Rural Health. Rural promising practice issue brief: GRECC Connect Project: connecting rural providers with geriatric specialists through telemedicine. https://www.ruralhealth.va.gov/docs/promise/2017_02_01_Promising%20Practice_GRECC_Issue%20Brief.pdf. Published February 2017. Accessed September 10, 2019.

17. US Department of Veterans Affairs, Office of Public and Intergovernmental Affairs. VA expands telehealth by allowing health care providers to treat patients across state lines [press release]. https://www.va.gov/opa/pressrel/pressrelease.cfm?id=4054. Published May 11, 2018. Accessed September 10, 2019.

18. US Department of Veterans Affairs. Department of Veterans Affairs FY 2018 – 2024 strategic plan. https://www.va.gov/oei/docs/VA2018-2024strategicPlan.pdf. Updated May 31, 2019. Accessed September 10, 2019.

Older rural veterans and their caregivers may benefit from this program through decreased travel-associated burden and report high satisfaction with these programs. Through a recently established collaboration with the GEC Data Analysis Center, we will use national data to refine our ability to identify at-risk, older rural veterans and to better evaluate their service needs and the GRECC Connect clinical impact. Because the VA is rapidly expanding use of telehealth and other virtual and digital methods to increase access to care, continued investments in telehealth are central to the VA 5-year strategic plan.¹⁸ In this spirit, GRECC Connect will continue to expand its program offerings and to leverage telehealth technologies to meet the needs of older veterans.

Acknowledgments

The authors wish to acknowledge Lisa Tenover, MD, PhD, (Palo Alto GRECC) for her contributions to this manuscript; the VA Rural Health Resource Center–Western Region; and GRECC Connect team members for their tireless work to ensure this project’s success. The GRECC Teams include Atlanta/Birmingham (Julia [Annette] Tedford, RN; Marquitta Cox, LMSW; Lisa Welch, LMSW; Mark Phillips; Lanie Walters, PharmD; Kroshona Tabb, PhD; Robert Langford, and Jason [Thomas] Sanders, HT, TCT); Bronx/NY Harbor (Ab Brody, RN; PhD, GNP-BC; Nick Koufacos, LMSW; and Shatice Jones); Canandaigua (Gary Kochersberger, MD; Suzanne Gillespie, MD; Gary Warner, PhD; Christie Hylwa, RPh CCP; Sharon Fell, LMSW; and Dorian Savino, MPA); Durham (Mamata Yanamadala, MBBS; Christy Knight, LCSW, MSW; and Julie Vognsen); Eastern Colorado (Larry Bourg, MD; Skotti Church, MD; Morgan Elmore, DO; Stephanie Hartz, LCSW; Carolyn Horney, MD; Steven Huart, AuD; Kathryn Nearing, PhD; Elizabeth O’Brien, PharmD; Laurence Robbins, MD; Robert Schwartz, MD; Karen Shea, MD; and Joleen Sussman, PhD); Little Rock (Prasad Padala, MD; and Tanya Taylor, RN); Madison (Ryan Bartkus, MD; Timothy Howell, MD; Lindsay Clark, PhD; Lauren Welch, PharmD, BCGP; Ellen Wanninger, MSW, CAPSW; Stacie Monson, RN, BSN; and Teresa Swader, MSW, LCSW); Miami (Carlos Gomez Orozo); New England (Malissa Kraft, PsyD); Palo Alto (Terri Huh, PhD, ABPP; Philip Choe, DO; Dawna Dougherty, LCSW; Ashley Scales, MPH); Pittsburgh (Stacey Shaffer, MD; Carol Dolbee, CRNP; Nancy Kovell, LCSW; Paul Bulgarelli, DO; Lauren Jost, PsyD; and Marcia Homer, RN-BC); and San Antonio (Becky Powers, MD; Che Kelly, RN, BSN; Cynthia Stewart, LCSW; Rebecca Rottman-Sagebiel, PharmD, BCPS, CGP; Melody Moris; Daniel MacCarthy; and Chen-pin Wang, PhD).