Alejandro Interian1, Arlene R King1, Lauren M St Hill1, Claire H Robinson1, Laura J Damschroder1. 1. Dr. Interian and Dr. King are with Mental Health and Behavioral Sciences, U.S. Department of Veterans Affairs (VA) New Jersey Health Care System, Lyons, New Jersey. Dr. Interian is also with the Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey. Ms. St. Hill is with the Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey. Ms. Robinson and Ms. Damschroder are with the Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
Abstract
OBJECTIVE: The Veterans Health Administration (VHA) has recently implemented video-to-home (V2H) telehealth as part of a strategy to improve access to mental health treatment. Implementation research of this modality is needed, given that V2H telehealth transforms the traditional face-to-face delivery of mental health services. To address this need, V2H implementation was evaluated by examining barriers and facilitators that were associated with level of staff V2H experience and factors that differentiated facilities with various levels of V2H performance. METHODS: Semistructured interviews with VHA personnel (N=33) from three facilities were conducted. The facilities were selected by overall number of mental health V2H visits during fiscal year (FY) 2015 as well as by growth in number of visits from FY 2014 through FY 2015. Factors influencing implementation were identified through qualitative analyses that contrasted responses by groups of participants with three different levels of V2H experience (no experience, limited experience, most experience) as well as three facilities that differed in V2H productivity (high visit count, high visit growth, and low visit count and low visit growth). RESULTS: Providers seemed to encounter different barriers and facilitators depending on their level of experience with V2H. Site-level analyses illustrated the importance of logistical support, especially for providers who are newly adopting the technology. Other factors that differentiated the facilities were also identified and described. CONCLUSIONS: Key factors related to implementation of V2H telehealth pertained to provider buy-in and logistical support. Facility-level strategies that address these factors may enhance provider progression from nonuse to sustained use.
OBJECTIVE: The Veterans Health Administration (VHA) has recently implemented video-to-home (V2H) telehealth as part of a strategy to improve access to mental health treatment. Implementation research of this modality is needed, given that V2H telehealth transforms the traditional face-to-face delivery of mental health services. To address this need, V2H implementation was evaluated by examining barriers and facilitators that were associated with level of staff V2H experience and factors that differentiated facilities with various levels of V2H performance. METHODS: Semistructured interviews with VHA personnel (N=33) from three facilities were conducted. The facilities were selected by overall number of mental health V2H visits during fiscal year (FY) 2015 as well as by growth in number of visits from FY 2014 through FY 2015. Factors influencing implementation were identified through qualitative analyses that contrasted responses by groups of participants with three different levels of V2H experience (no experience, limited experience, most experience) as well as three facilities that differed in V2H productivity (high visit count, high visit growth, and low visit count and low visit growth). RESULTS: Providers seemed to encounter different barriers and facilitators depending on their level of experience with V2H. Site-level analyses illustrated the importance of logistical support, especially for providers who are newly adopting the technology. Other factors that differentiated the facilities were also identified and described. CONCLUSIONS: Key factors related to implementation of V2H telehealth pertained to provider buy-in and logistical support. Facility-level strategies that address these factors may enhance provider progression from nonuse to sustained use.
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Received January 4, 2017; accepted June 29, 2017; implementation science; mental health; mixed-methods; published online September 1, 2017; revisions received April 14 and June 8, 2017; telehealth
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