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2023 HSR&D/QUERI National Conference Abstract

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4026 — Accessing Telehealth through Local Area Stations (ATLAS), the provider and community partner perspective

Lead/Presenter: Lauren Stevenson,  VA Northeast Ohio Healthcare System
All Authors: Stevenson LD (VA Northeast Ohio Healthcare System, Cleveland, OH, USA), Barnard, J (Rocky Mountain Regional VA Medical Center, Aurora, CO, USA, University of Colorado School of Medicine, Aurora, CO, USA), Lee, M (Rocky Mountain Regional VA Medical Center, Aurora, CO, USA), Kenney, R (Rocky Mountain Regional VA Medical Center, Aurora, CO, USA), Miller, E (Rocky Mountain Regional VA Medical Center, Aurora, CO, USA) Sayre, G (Veterans Affairs Puget Sound Health Care System, Seattle, WA, University of Washington, Seattle, WA)

Objectives:
As a part of the Anywhere-to-Anywhere Telehealth initiative, Accessing Telehealth through Local Area Stations (ATLAS) was initiated in FY19 to enhance the accessibility of VA health care and help bridge the digital divide by establishing comfortable, private telehealth locations for Veterans with long drives to VA facilities or poor internet connectivity at home. Partnerships were formed with VSOs (ie. VFW, AL) and a retail partner (Walmart) to establish ATLAS sites for veterans to visit and receive support accessing VA telehealth. Our goal was to evaluate the implementation of ATLAS.

Methods:
Recruitment and interviews of VA providers and staff involved with local ATLAS sites were conducted by evaluators trained in conducting qualitative interviews between September 2021 and June 2002. Semi-structured interview guides were developed specific to role (VA provider, scheduler, ATLAS attendant) and used to conduct interviews via web-based video conference connection to record. All interviews were transcribed verbatim by a professional transcriptionist. Team-based deductive and inductive content analysis was conducted to enhance reflexivity, and identify themes associated implementation of ATLAS.

Results:
Interviews were conducted with 39 staff and providers from 9 VAMCs affiliated with ATLAS sites, as well as 9 non-VA partners at ATLAS sites. Buy-in for ATLAS from providers was found, yet a lack of promotion of the program within the VA occurred in some areas. Scheduling was sometimes a challenge, particularly if veterans initiated by calling a VA scheduling line. Rural veterans experienced ease of use to access telehealth at an ATLAS location and reduced travel and time burden to access VA telehealth according to interview participants. They also reported belief that ATLAS was an acceptable option for VA telehealth for veterans without reliable WiFi, personal devices, or who lacked technological savvy to connect to video appointments. Covid-19 response began mid-evaluation of ATLAS implementation. Delays in implementation, expansion and concern about safety impacted the use of community ATLAS locations. Some staff and providers reported Veterans had concerns about the safety of visiting an ATLAS site due to Covid-19 risk, while they felt other Veterans felt more comfortable or at lower risk at a local ATLAS location than having a face-to-face appointment at a VAMC.

Implications:
ATLAS is a program aimed at providing telehealth access to rural veterans for those unable or uninterested in receiving virtual care from home or on a personal device. ATLAS appeared to provide equipment, WiFi and supportive staffing to help rural veterans connect with their VA providers. Alternative locations including VSOs and Walmart may allow veterans access to their VA providers from a secure and private space without a drive to the VAMC. Enhancement in promotion to Veterans improved the use of ATLAS sites. Availability of an alternative location for an appointment when Veterans were concerned about Covid-19 risk in a smaller setting was an unintended benefit.

Impacts:
Despite the necessity of having telehealth appointments available the last several years during Covid-19 response, our evaluation highlighted the importance of provider buy-in for successful implementation of telehealth programs aimed at increasing access in rural areas.