JMIR Publications

ABSTRACT

Background:

The Veterans Health Administration Clinical Resource Hubs (CRHs) are regional telehealth hubs that cover gaps in health care access. One gap addressed by CRHs is access to specialty tele-geriatric mental health (tele-GMH) care for aging rural Veterans.

Objective:

We conducted a qualitative longitudinal evaluation of care delivered via CRH tele-GMH teams and sought to create a roadmap describing key phases and determinants underlying implementation and sustainment of tele-GMH services.

Methods:

Clinicians from 8 tele-GMH teams (n = 25) were interviewed at 3 timepoints across a three-year period (October 2021-September 2024). Interviews (n = 46) were recorded, transcribed, and summarized via a templated rapid qualitative approach, guided by the Consolidated Framework for Implementation Research 2.0. Findings characterize variations in team compositions and approaches to care (i.e., consultative, continuity, and hybrid models of care).

Results:

We identified key activities and determinants of success in three phases: (1) pre-implementation (engaging leaders, securing funding/hiring, and defining services); (2) implementation scale-up and expansion (advertising, addressing challenges, seeking feedback, refining, and growth); and (3) sustainment (maintenance). Steps within each phase were cyclical and iterative (i.e., non-linear). Barriers to implementation included unfamiliarity with local aging resources; facilitators included tailoring strategies and engaging referring clinicians.

Conclusions:

These findings demonstrate that similar processes emerged across regions in the development and sustainment of tele-GMH services, which allowed for creation of a unified roadmap. The roadmap provides a pathway that other regions may follow to create tele-GMH services to enhance access to specialty care for aging rural Veterans.