Attaining access and comfort: providers' qualitative feedback on a tele-geriatric psychiatry consultation service within the veterans health administration

Introduction Delivering geriatric psychiatry services through telehealth increases equitable access to this specialty, especially for those residing in rural areas. One such telehealth approach uses consultative care via patient referral from providers across the continuum of care including primary care, inpatient care, and nursing homes. Perceptions of access and comfort with the consultative process and experience were qualitatively analyzed to better understand providers’ motivations for referring patients to this consult service and benefits received from the service. Methods Interviews were conducted with Veterans Health Administration providers who referred patients to a tele-geriatric psychiatry consultation service between October 2020 and September 2021. Eleven qualitative semi-structured interviews were completed offering feedback regarding the consultation experience and impact. Qualitative analysis began using summary template analysis to create domains based on the interview questions. Changes to the template were made based on consensus and all interviews were coded. Master domain summaries were created and re-categorized by grouping related ideas and themes. Two of the multi-source summaries created included, ‘Consultation Experience & Most Helpful Aspects’ and ‘Service Impacts, Access & Comfort Changes.’ Results The tele-geriatric psychiatry consultation service was described as purely consultative assistance guiding clinical workup and providing recommendations from either a chart-review or clinical encounter with the patient over telehealth. The most highly valued features focused on the consultant's knowledge, collaboration, communication and trustworthiness, the ease of the consultation process, and accessibility. Access impacted both providers and patients. One provider spoke of finding specialized care “I don't think there's even community geriatric psychiatry out here, if there is, it would be hard to find.” Many providers had increased levels of comfort caring for geriatric patients after having direct or indirect education from the geriatric psychiatrist. One provider acknowledged, “It's been very educational. Just her approach to talking with some of these patients and-like the questions that she'll ask…” Providers reported gaining specific knowledge about medication dosing in older patients and behavioral approaches to supporting patients with distress behaviors. Conclusions Referring providers reported the tele-geriatric psychiatry consultation service was accessible, timely and collaborative. Providers experienced increased comfort and decreased burden from having access to the geriatric psychiatrist's expertise and assistance with patients experiencing distress. Additionally, the geriatric psychiatrist's example and collaboration benefited the provider both immediately and in future encounters. Expansion of services like this one may be beneficial for other rural sites and providers. This research was funded by VA Office of Rural Health Delivering geriatric psychiatry services through telehealth increases equitable access to this specialty, especially for those residing in rural areas. One such telehealth approach uses consultative care via patient referral from providers across the continuum of care including primary care, inpatient care, and nursing homes. Perceptions of access and comfort with the consultative process and experience were qualitatively analyzed to better understand providers’ motivations for referring patients to this consult service and benefits received from the service. Interviews were conducted with Veterans Health Administration providers who referred patients to a tele-geriatric psychiatry consultation service between October 2020 and September 2021. Eleven qualitative semi-structured interviews were completed offering feedback regarding the consultation experience and impact. Qualitative analysis began using summary template analysis to create domains based on the interview questions. Changes to the template were made based on consensus and all interviews were coded. Master domain summaries were created and re-categorized by grouping related ideas and themes. Two of the multi-source summaries created included, ‘Consultation Experience & Most Helpful Aspects’ and ‘Service Impacts, Access & Comfort Changes.’ The tele-geriatric psychiatry consultation service was described as purely consultative assistance guiding clinical workup and providing recommendations from either a chart-review or clinical encounter with the patient over telehealth. The most highly valued features focused on the consultant's knowledge, collaboration, communication and trustworthiness, the ease of the consultation process, and accessibility. Access impacted both providers and patients. One provider spoke of finding specialized care “I don't think there's even community geriatric psychiatry out here, if there is, it would be hard to find.” Many providers had increased levels of comfort caring for geriatric patients after having direct or indirect education from the geriatric psychiatrist. One provider acknowledged, “It's been very educational. Just her approach to talking with some of these patients and-like the questions that she'll ask…” Providers reported gaining specific knowledge about medication dosing in older patients and behavioral approaches to supporting patients with distress behaviors. Referring providers reported the tele-geriatric psychiatry consultation service was accessible, timely and collaborative. Providers experienced increased comfort and decreased burden from having access to the geriatric psychiatrist's expertise and assistance with patients experiencing distress. Additionally, the geriatric psychiatrist's example and collaboration benefited the provider both immediately and in future encounters. Expansion of services like this one may be beneficial for other rural sites and providers.