Impact and Sustainability of Tele-Geriatric Mental Services for Rural Veterans and Other Stakeholders

Introduction A tele-geriatric mental health service (Tele-GMH) offered through four regional Veterans Health Administration (VHA) service networks aims to meet the specialized geriatric mental health needs of older Veterans residing in rural areas. Prior to these services, access to specialty geriatric mental healthcare was either non-existent or very limited for many rural Veterans. The composition of each Tele-GMH team varies, consisting of different disciplines including geriatric psychiatrists, geropsychologists, and a geriatric pharmacy specialist. Interviews were conducted with providers to assess the perceived impact and sustainability of these services on multiple stakeholders. Methods We interviewed eight Tele-GMH providers regarding service implementation, leadership support, and benefits to stakeholders (including Veterans and Caregivers). For Tele-GMH programs operating for a year or more, we inquired about service outcomes and indicators of sustainability. Interviews were transcribed and analyzed using a team-based rapid qualitative analysis approach. Results While the initiation of services often presented with challenges, once established, telehealth services seemed to promote positive rapport-building with Veterans, caregivers, and referring providers. Providers reported that referring providers' burden was lessened with the assistance of the Tele-GMH service providers who specialize in caring for patients who are often medically complex with multi-morbidities. For Veterans and caregivers, Tele-GMH providers have seen increased self-efficacy, decreased nursing home stays, increased resource identification, and improved care and management of dementia symptoms. According to Tele-GMH providers, leadership support was integral in the overall success and sustainability of Tele-GMH services. Perceived positive outcomes for all stakeholders have led to team expansion, workflow changes, program growth and indications of sustainability and Tele-GMH provider retention. Conclusions In four VHA service networks, Tele-GMH services continue to thrive after initial implementation. Benefits reported by Tele-GMH providers indicate the service is improving access and meeting referring provider and Veteran needs. These findings are indicative of service sustainability.