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Telehealth Collaborative Care

Summary 
  • Need: To increase access to specialty care for rural veterans living with HIV.
  • Intervention: The Telehealth Collaborative Care (TCC) study connects these patients with HIV specialists via clinical video telehealth or VA video connect and works to create shared care relationships with primary care teams in rural areas.
  • Results: TCC provides HIV specialty care access to rural veterans in a sustainable manner with infrastructure, mentorship, and capacity building.

Description

According to a VA news release, approximately 26,000 veterans received VA care for HIV in 2017. Of these vets, about 18% lived in rural areas, where access to high-quality specialty care is limited.

Rural veterans with HIV are more likely than their urban counterparts to enter care with more advanced illness and less likely to receive the most recent advances in HIV treatment. In addition, rural veterans with HIV have lower survival rates.

The Telehealth Collaborative Care (TCC) study works to improve care for these patients by connecting veterans in rural areas to HIV specialists in urban VA hospitals. TCC began in Georgia and Texas and has since expanded to include Arizona, Florida, Indiana, Louisiana, Maine, Mississippi, Ohio, Oregon, and Washington.

Researchers received funding from VA's Office of Rural Health and Health Services Research and Development (HSR&D) program to develop, evaluate, and implement a program that would improve access to specialty care for rural veterans with HIV.

Services offered

Patients attend their videoconferencing sessions at the nearest VA community-based outpatient clinic (CBOC) and receive care from distant HIV specialty care teams. Patients can also complete VA video connect visits in their own homes or a secure office space. Services include maintaining HIV care and ensuring associated care metrics as coordinated with the primary care provider. Along with the patients and specialists, video conference sessions can include:

  • Advanced nurse care managers
  • Pharmacists
  • Primary care physicians (PCPs)
  • Telehealth specialists

In addition, local primary care teams work with the distant HIV specialists to provide "shared care" for rural veterans with HIV. The rural primary care teams focus on reducing cardiovascular risk by treating high blood pressure, diabetes, hyperlipidemia, and tobacco smoking.

Results

Researchers offered the telehealth option to veterans who live closer to a CBOC or primary care clinic than to a VA hospital with HIV specialty care and who have to drive at least 90 minutes to one of these clinics. Most veterans (90% in the pilot studies) chose the telehealth option and were satisfied or very satisfied with their care.

Rates of HIV viral control remained high (over 90%) and smoking cessation care processes improved. Results for impacts on care outcomes in replication studies show improvement in retention in care in telehealth intervention clinics.

The program has been replicated in VA sites across the country in 2019, with additional evaluations ongoing. With the COVID-19 pandemic, there has been successful uptake of VA Video Connect visits, which has accelerated the uptake of telehealth technologies for HIV care in addition to enhancing the collaborative model between primary care and HIV specialists.

For more information about TCC:

Ohl, M.E., Richardson, K., Rodriguez-Barradas, M.C., Bedimo, R., Marconi, V., Morano, J.P., … & Vaughan-Sarrazin, M. (2019). Impact of Availability of Telehealth Programs on Documented HIV Viral Suppression: A Cluster-Randomized Program Evaluation in the Veterans Health Administration. Open Forum Infectious Diseases, 6(6).

Barriers

Rural primary care teams have multiple competing demands for their limited time. This barrier can be overcome by providing additional support to rural primary care teams with HIV care managers at the telehealth hub site who can work directly with veterans by telephone. This program is also utilizing VA video connect and video on demand services to expand reach to rural veterans due to high demand.

Other barriers to care in rural areas are limited internet or cellular capabilities, despite the availability of specialists on these modalities. This program works with each participating site to work through options for connected care utilizing resource-specific amenities.

Replication

This program can be replicated in rural areas served by clinics with potential telehealth connections to HIV specialty clinics. Shared care relationships between distant HIV specialists and local primary care teams can start with a narrow focus on engaging primary care teams in cardiovascular risk factor management and expand from there.

Some rural patients with HIV may prefer to attend telehealth visits in a clinic that is near enough to be accessible but far enough from home to avoid concerns about loss of privacy.

Contact Information

Jamie P. Morano, MD, MPH, FACP, Project Lead
National HIV Telehealth Connected Care Program
Jamie.Morano@va.gov

Topics
HIV and AIDS
Telehealth
Veterans

States served
National/Multi-State, Georgia, Texas

Date added
July 21, 2017

Date updated or reviewed
September 2, 2020


Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.