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Delivering fracture prevention services to rural US veterans through telemedicine: a process evaluation.
Miller, Karla L; Steffen, Melissa J; McCoy, Kimberly D; Cannon, Grant; Seaman, Aaron T; Anderson, Zachary L; Patel, Shardool; Green, Janiel; Wardyn, Shylo; Solimeo, Samantha L.
Afiliación
  • Miller KL; VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT, USA. Karla.Miller@va.gov.
  • Steffen MJ; Department of Internal Medicine, Rheumatology Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA. Karla.Miller@va.gov.
  • McCoy KD; Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT, USA. Karla.Miller@va.gov.
  • Cannon G; VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT, USA.
  • Seaman AT; VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Salt Lake City, UT, USA.
  • Anderson ZL; Comprehensive Access & Delivery Research and Evaluation (CADRE), Primary Care Analytics Team Iowa City (PCAT-IC), Department of Veterans Affairs, CADRE, Iowa City VA HCS, Research 152, 601 Highway 6 West, Iowa City, IA, 52246, USA.
  • Patel S; VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Salt Lake City, UT, USA.
  • Green J; Comprehensive Access & Delivery Research and Evaluation (CADRE), Primary Care Analytics Team Iowa City (PCAT-IC), Department of Veterans Affairs, CADRE, Iowa City VA HCS, Research 152, 601 Highway 6 West, Iowa City, IA, 52246, USA.
  • Wardyn S; Department of Internal Medicine, Rheumatology Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.
  • Solimeo SL; VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Salt Lake City, UT, USA.
Arch Osteoporos ; 16(1): 27, 2021 02 10.
Article en En | MEDLINE | ID: mdl-33566174
An informatics-driven population bone health clinic was implemented to identify, screen, and treat rural US Veterans at risk for osteoporosis. We report the results of our implementation process evaluation which demonstrated BHT to be a feasible telehealth model for delivering preventative osteoporosis services in this setting. PURPOSE: An established and growing quality gap in osteoporosis evaluation and treatment of at-risk patients has yet to be met with corresponding clinical care models addressing osteoporosis primary prevention. The rural bone health tea m (BHT) was implemented to identify, screen, and treat rural Veterans lacking evidence of bone health care and we conducted a process evaluation to understand BHT implementation feasibility. METHODS: For this evaluation, we defined the primary outcome as the number of Veterans evaluated with DXA and a secondary outcome as the number of Veterans who initiated prescription therapy to reduce fracture risk. Outcomes were measured over a 15-month period and analyzed descriptively. Qualitative data to understand successful implementation were collected concurrently by conducting interviews with clinical personnel interacting with BHT and BHT staff and observations of BHT implementation processes at three site visits using the Promoting Action on Research Implementation in Health Services (PARIHS) framework. RESULTS: Of 4500 at-risk, rural Veterans offered osteoporosis screening, 1081 (24%) completed screening, and of these, 37% had normal bone density, 48% osteopenia, and 15% osteoporosis. Among Veterans with pharmacotherapy indications, 90% initiated therapy. Qualitative analyses identified barriers of rural geography, rural population characteristics, and the infrastructural resource requirement. Data infrastructure, evidence base for care delivery, stakeholder buy-in, formal and informal facilitator engagement, and focus on teamwork were identified as facilitators of implementation success. CONCLUSION: The BHT is a feasible population telehealth model for delivering preventative osteoporosis care to rural Veterans.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Osteoporosis / Veteranos / Telemedicina Tipo de estudio: Diagnostic_studies / Evaluation_studies / Prognostic_studies / Qualitative_research Límite: Humans Idioma: En Revista: Arch Osteoporos Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Osteoporosis / Veteranos / Telemedicina Tipo de estudio: Diagnostic_studies / Evaluation_studies / Prognostic_studies / Qualitative_research Límite: Humans Idioma: En Revista: Arch Osteoporos Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido