Aging Clin Exp Res DOI 10.1007/s40520-015-0317-4
LETTER TO THE EDITOR
Telehealth can meet the health care needs of aging rural veterans Aung Zaw Win
Received: 27 December 2014 / Accepted: 10 January 2015 Ó Springer International Publishing Switzerland 2015
The Veterans Health Administration (VHA) is America’s largest integrated health care system with over 1,700 sites of care, serving 8.9 million Veterans each year. Veterans are an underserved and disenfranchised population. The veteran patients are mostly male and the median age is 65 and most of the patients have lower household incomes compared to the general public. VHA has emerged as a national and international leader in the delivery and research of telehealth-based treatment. Currently, the VA offers telehealth services in 44 subspecialties. VA telehealth programs are achieving successes. Psychotherapy treatments delivered by interactive videos are equivalent to therapy given in person [1]. The VA is the largest provider of telemental health services in the country and in the world. A VA quality management study found that telehealth reduces the hospitalization of patients, and it is cost effective and associated with higher levels of patient satisfaction. Moreover, telemedicine improves rapport with patients [2]. Telemedicine is emerging as an effective way to provide consultation and care to rural aging residents who may not have access to specialty services. 5.3 million of the nation’s 22 million veterans live in rural areas and three-fourths of rural veterans are over the age of 55. Most rural veterans live in poverty. Additionally, rural veterans in general have worse health-related quality of life. There are many knowledge gaps in the literature on rural veterans’ health care needs. Mortality after the age of 65 for male VA users is higher in rural dwellers than in urban dwellers [3]. Travel distance is a major barrier to A. Z. Win (&) Notre Dame de Namur University, 1500 Ralston Avenue, Belmont, CA 94002, USA e-mail: [email protected]
seek health care for veterans age 65 and older [4]. On average, rural aging veterans enrolled with VA for care travel between 60 and 120 min for inpatient care, and 30 and 90 min for primary care [5]. Telehealth not only continues to provide aging Veterans access to VA health care closer to their homes, but it is also making an environmental impact by reducing carbon dioxide emission from cars. In just 6 out of 151 VA Medical Centers, telehealth allowed the aging veterans to avoid driving over 10 million miles to receive medical care. Since Telehealth Care is part of the VHA Standard Medical Benefits Package, all enrolled senior and aging Veterans are eligible. VA’s telehealth services are growing by 70 % annually. Telehealth is enabling 90,000 elderly veterans with a chronic condition to live independently. The VA waived patient co-pays for telehealth visits in 2012. The House introduced the Veterans E-Health & Telemedicine Support Act of 2012 that would remove restrictions for VA providers to treat patients using remote technology across state lines. 21st Century Care for Military and Veterans Act permits the use of a telecommunications system to provide telehealth services to current and former members of the uniformed services and their dependents. In fiscal year 2013, VA-specific telehealth applications grew to more than 608,000 patients at 151 VA medical centers and 705 community-based outpatient clinics resulted in roughly 1.8 million telehealth episodes of care. In the 2014 fiscal year, the VA Telehealth Program served more than 690,000 veterans and accounted to more than 2 million telehealth visits. Telemedicine is a prominent part of the 2014 VA reform bill which allocated $16.3 billion to overhaul the US Department of Veterans Affairs. The legislation was passed to reduce extensive wait times to see a doctor, which sparked the 2014 VA scandal. The new bill
123
Aging Clin Exp Res
requires that all VA mobile medical centers have the capability to provide telemedicine services. The bill also requires an annual report be sent to Congress outlining the use of telemedicine by such centers. The American Telemedicine Association applauded the legislation’s inclusion of telemedicine provisions, calling it ‘‘a great step toward overall improvement’’ of care delivery. Thus, the VA remains at the van guard of telehealth. Advances in telehealth by VHA for the aging veterans can be adapted to address a greater range of healthcare needs among other populations in hard-to-reach settings.
2.
3.
4.
5. Conflict of interest of interest.
The authors declare that they have no conflict
References 1. Fortney JC, Pyne JM, Kimbrell TA, Hudson TJ, Robinson DE, Schneider R, Moore WM, Custer PJ, Grubbs KM, Schnurr PP
123
(2014) Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2014.1575 Hopp F, Whitten P, Subramanian U, Woodbridge P, Mackert M, Lowery J (2006) Perspectives from the Veterans Health Administration about opportunities and barriers in telemedicine. J Telemed Telecare 12(8):404–409 Mackenzie TA, Wallace AE, Weeks WB (2010) Impact of rural residence on survival of male veterans affairs patients after age 65. J Rural Health 26(4):318–324 Buzza C, Ono SS, Turvey C, Wittrock S, Noble M, Reddy G, Kaboli PJ, Reisinger HS (2011) Distance is relative: unpacking a principal barrier in rural healthcare. J Gen Intern Med 26(Suppl 2):648–654 http://www.hsrd.research.va.gov/publications/internal/forum10_10. pdf
LETTER TO THE EDITOR
Telehealth can meet the health care needs of aging rural veterans Aung Zaw Win
Received: 27 December 2014 / Accepted: 10 January 2015 Ó Springer International Publishing Switzerland 2015
The Veterans Health Administration (VHA) is America’s largest integrated health care system with over 1,700 sites of care, serving 8.9 million Veterans each year. Veterans are an underserved and disenfranchised population. The veteran patients are mostly male and the median age is 65 and most of the patients have lower household incomes compared to the general public. VHA has emerged as a national and international leader in the delivery and research of telehealth-based treatment. Currently, the VA offers telehealth services in 44 subspecialties. VA telehealth programs are achieving successes. Psychotherapy treatments delivered by interactive videos are equivalent to therapy given in person [1]. The VA is the largest provider of telemental health services in the country and in the world. A VA quality management study found that telehealth reduces the hospitalization of patients, and it is cost effective and associated with higher levels of patient satisfaction. Moreover, telemedicine improves rapport with patients [2]. Telemedicine is emerging as an effective way to provide consultation and care to rural aging residents who may not have access to specialty services. 5.3 million of the nation’s 22 million veterans live in rural areas and three-fourths of rural veterans are over the age of 55. Most rural veterans live in poverty. Additionally, rural veterans in general have worse health-related quality of life. There are many knowledge gaps in the literature on rural veterans’ health care needs. Mortality after the age of 65 for male VA users is higher in rural dwellers than in urban dwellers [3]. Travel distance is a major barrier to A. Z. Win (&) Notre Dame de Namur University, 1500 Ralston Avenue, Belmont, CA 94002, USA e-mail: [email protected]
seek health care for veterans age 65 and older [4]. On average, rural aging veterans enrolled with VA for care travel between 60 and 120 min for inpatient care, and 30 and 90 min for primary care [5]. Telehealth not only continues to provide aging Veterans access to VA health care closer to their homes, but it is also making an environmental impact by reducing carbon dioxide emission from cars. In just 6 out of 151 VA Medical Centers, telehealth allowed the aging veterans to avoid driving over 10 million miles to receive medical care. Since Telehealth Care is part of the VHA Standard Medical Benefits Package, all enrolled senior and aging Veterans are eligible. VA’s telehealth services are growing by 70 % annually. Telehealth is enabling 90,000 elderly veterans with a chronic condition to live independently. The VA waived patient co-pays for telehealth visits in 2012. The House introduced the Veterans E-Health & Telemedicine Support Act of 2012 that would remove restrictions for VA providers to treat patients using remote technology across state lines. 21st Century Care for Military and Veterans Act permits the use of a telecommunications system to provide telehealth services to current and former members of the uniformed services and their dependents. In fiscal year 2013, VA-specific telehealth applications grew to more than 608,000 patients at 151 VA medical centers and 705 community-based outpatient clinics resulted in roughly 1.8 million telehealth episodes of care. In the 2014 fiscal year, the VA Telehealth Program served more than 690,000 veterans and accounted to more than 2 million telehealth visits. Telemedicine is a prominent part of the 2014 VA reform bill which allocated $16.3 billion to overhaul the US Department of Veterans Affairs. The legislation was passed to reduce extensive wait times to see a doctor, which sparked the 2014 VA scandal. The new bill
123
Aging Clin Exp Res
requires that all VA mobile medical centers have the capability to provide telemedicine services. The bill also requires an annual report be sent to Congress outlining the use of telemedicine by such centers. The American Telemedicine Association applauded the legislation’s inclusion of telemedicine provisions, calling it ‘‘a great step toward overall improvement’’ of care delivery. Thus, the VA remains at the van guard of telehealth. Advances in telehealth by VHA for the aging veterans can be adapted to address a greater range of healthcare needs among other populations in hard-to-reach settings.
2.
3.
4.
5. Conflict of interest of interest.
The authors declare that they have no conflict
References 1. Fortney JC, Pyne JM, Kimbrell TA, Hudson TJ, Robinson DE, Schneider R, Moore WM, Custer PJ, Grubbs KM, Schnurr PP
123
(2014) Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2014.1575 Hopp F, Whitten P, Subramanian U, Woodbridge P, Mackert M, Lowery J (2006) Perspectives from the Veterans Health Administration about opportunities and barriers in telemedicine. J Telemed Telecare 12(8):404–409 Mackenzie TA, Wallace AE, Weeks WB (2010) Impact of rural residence on survival of male veterans affairs patients after age 65. J Rural Health 26(4):318–324 Buzza C, Ono SS, Turvey C, Wittrock S, Noble M, Reddy G, Kaboli PJ, Reisinger HS (2011) Distance is relative: unpacking a principal barrier in rural healthcare. J Gen Intern Med 26(Suppl 2):648–654 http://www.hsrd.research.va.gov/publications/internal/forum10_10. pdf
