Mixed-Methods Evaluation of a Telehealth Collaborative Care Program for Persons with HIV Infection in a Rural Setting

Michael OHL; Dena DILLON; Jane MOECKLI; Sarah ONO; Nancee WATERBURY; Jo SISSEL; JUN YIN; Brian NEIL; Bonnie WAKEFIELD; Peter KABOLI

doi:10.1007/s11606-013-2385-5

Back

Mixed-Methods Evaluation of a Telehealth Collaborative Care Program for Persons with HIV Infection in a Rural Setting

Journal article

Open access

Peer reviewed

Mixed-Methods Evaluation of a Telehealth Collaborative Care Program for Persons with HIV Infection in a Rural Setting

Michael OHL, Dena DILLON, Jane MOECKLI, Sarah ONO, Nancee WATERBURY, Jo SISSEL, JUN YIN, Brian NEIL, Bonnie WAKEFIELD and Peter KABOLI

Journal of general internal medicine : JGIM, Vol.28(9), pp.1165-1173

2013

DOI: 10.1007/s11606-013-2385-5

PMCID: PMC3744312

PMID: 23475640

Files and links (1)

url

https://doi.org/10.1007/s11606-013-2385-5View

Published (Version of record) Open Access

Abstract

BACKGROUND Delivery of comprehensive care for persons with human immunodeficiency virus (HIV) infection in rural and low prevalence settings presents many challenges. We developed and evaluated a telehealth collaborative care (TCC) program for persons with HIV in a rural area. OBJECTIVE To determine the feasibility of TCC, and identify factors influencing implementation in rural settings. DESIGN Mixed methods evaluation of a quality improvement program with pre-measures and post-measures. PATIENTS Veterans with HIV infection in Iowa and Illinois. INTERVENTION TCC integrated HIV specialty care delivered by clinical video telehealth, with primary care delivered by generalist providers, in seven Community Based Outpatient Clinics (CBOCs) serving rural areas. Principles guiding TCC design were: 1) clear delineation of specialty and primary care clinic roles in co-managed care; 2) creation of processes to improve care coordination between specialty and primary care teams; and 3) use of a patient registry for population management across sites. MEASURES Veterans Affairs (VA) healthcare system performance measures for care for HIV infection and common comorbidities, patient travel time to obtain care, and patient satisfaction. Qualitative evaluation involved semi-structured telephone interviews with patients. KEY RESULTS Thirty of 32 eligible patients chose TCC over traveling to the HIV clinic for all care. Among 24 patients in TCC during the June 2011–May 2012 evaluation period, median age was 54 (range, 40–79), most (96 %) were men, and median CD4 count was 707 cells/cm3 (range, 233–1307). VA performance measures were met for > 90 % of TCC patients. Median yearly travel time decreased from 320 min per patient prior to TCC to 170 min during TCC (p < 0.001). Interview themes included: 1) overcoming privacy concerns during care in local primary care clinics; 2) tradeoffs between access, continuity, and care coordination; and 3) the role of specialist involvement in collaborative care. DISCUSSION Telehealth Collaborative Care is a feasible approach to providing accessible and comprehensive care for persons with HIV in rural settings.

Infectious Diseases

Public health. Hygiene-occupational medicine

Public health. Hygiene

General aspects

Miscellaneous

Viral diseases

Viral diseases of the lymphoid tissue and the blood. Aids

Biological and medical sciences

Medical sciences

Human viral diseases

Details

Title: Subtitle: Mixed-Methods Evaluation of a Telehealth Collaborative Care Program for Persons with HIV Infection in a Rural Setting
Creators: Michael OHL - VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Central Region, Iowa City VAMC, Iowa City, IA, United States
Dena DILLON - VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Central Region, Iowa City VAMC, Iowa City, IA, United States
Jane MOECKLI - VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Central Region, Iowa City VAMC, Iowa City, IA, United States
Sarah ONO - VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Central Region, Iowa City VAMC, Iowa City, IA, United States
Nancee WATERBURY - Iowa City VA Healthcare System, Iowa City, IA, United States
Jo SISSEL - Iowa City VA Healthcare System, Iowa City, IA, United States
JUN YIN - Department of Biostatistics, University of Iowa Carver College of Medicine, Iowa City, IA, United States
Brian NEIL - Veterans Integrated Service Network (VISN) 23, Veterans Affairs Healthcare System, Minneapolis, MN, United States
Bonnie WAKEFIELD - VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Central Region, Iowa City VAMC, Iowa City, IA, United States
Peter KABOLI - VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Central Region, Iowa City VAMC, Iowa City, IA, United States
Resource Type: Journal article
Publication Details: Journal of general internal medicine : JGIM, Vol.28(9), pp.1165-1173
Publisher: Springer
DOI: 10.1007/s11606-013-2385-5
PMID: 23475640
PMCID: PMC3744312
ISSN: 0884-8734
eISSN: 1525-1497
Language: English
Date published: 2013
Academic Unit: Psychiatry; Epidemiology; Biostatistics; Pharmacy Practice and Science; Internal Medicine
Record Identifier: 9984094344602771

Metrics

8 Record Views

43 Times Cited - Web of Science

See more details