JMIR Publications

ABSTRACT

Background:

Occupational therapy (OT) is a vital service supporting older adults’ ability to age-in-place. Given barriers to accessing care, video telehealth is one means of providing OT services. Even within Veterans Health Administration (VHA), a pioneer in telehealth, video telehealth by OT practitioners to serve older adults is not well-understood.

Objective:

Utilizing an implementation framework, this study sought to understand VHA OT practice using video telehealth with older Veterans.

Methods:

A web-based national survey of VHA occupational therapy practitioners conducted in September-October 2019 contained a mix of mostly closed questions with some open text options. Questions were developed using the Promoting Action on Research Implementation in Health Services model with input from subject matter experts. Questions gathered the extent to which VHA OT practitioners utilize video telehealth to serve older Veterans, are comfortable with video telehealth to deliver specific OT services, and, for those using video telehealth with older Veterans, the barriers, facilitators of change, and perceived benefits of video telehealth.

Results:

305 VHA occupational therapy practitioners (21% response rate) participated in the survey. Most were female (84%), Master’s-educated (58%), occupational therapists (92%) with ten years or fewer (54%) of VHA OT practice. Less than half (41%) had used video telehealth with older Veterans, and users and non-users of video telehealth were demographically similar. When asked to rate perceived comfort with use of video telehealth to deliver OT services, participants who used video telehealth expressed greater comfort than those not using video telehealth, which was significant for nine out of thirteen OT interventions, including Activities of Daily Living (P <.001), Instrumental Activities of Daily Living (P = .004), Home Safety (P <.001), and Home Exercise/Therapeutic Exercise (P <.001). Half (50%) of those using video telehealth encountered at least one barrier, with “Inadequate space, physical locations and related equipment,” the most frequently endorsed. Most (83%) respondents utilizing video telehealth reported at least one facilitator, with most frequently endorsed facilitators reflecting respondent attitudes, including the belief that video telehealth would improve Veteran access to care (83%) and willingness to try innovative approaches (82%).

Conclusions:

Most VHA OTs who responded to the survey had not used video telehealth with older Veterans, and those utilizing video telehealth with older Veterans were similar demographically to those not using video telehealth. Differences in percentages of respondents feeling comfortable with video telehealth for specific OT interventions suggest that some OT services may be more amenable to video telehealth. This, coupled with the primacy of respondent beliefs versus organizational factors as facilitators, underscores the need to gather clinician attitudes to better understand how they are driving implementation of video telehealth.