The Potential of an Embedded Mental Health Services Program Toward Increasing Health Care-Seeking Behaviors Among U.S. Air Force Aircrew: A Mixed-Methods Study.

INTRODUCTION: The U.S. Air Force implemented the Integrated Operational Support model, which involves embedding health care professionals within operational units to meet the health needs of the airmen. This study assessed the extent to which airmen sought out both traditional and embedded mental health services, as well as perceptions of factors that hinder or encourage health care-seeking behaviors. MATERIALS AND METHODS: A mixed-methods approach including a web-based occupational psychological health assessment and semi-structured interviews was used to assess airmen's experiences with seeking mental health care services. RESULTS: A total of 447 Remotely Piloted Aircraft operators participated in an occupational psychological health assessment (42% response rate) in 2018, and 15 airmen across five high operational tempo, restricted-access installations completed a semi-structured interview (60% participation rate) in 2021. From the occupational assessment, females (33%) sought care from the traditional mental health clinic significantly more than males (21%; χ2 = 5.10, P = .02). However, there were no significant gender differences in seeking embedded mental health services. Respondents who had not sought out help from either the traditional clinic or embedded services were significantly more likely to seek assistance from embedded mental health services (M = 4.29, SD = 2.09) over the traditional clinic (M = 3.92, SD = 1.90), t(205) = 4.94, P < .001. A resounding interview theme was the deep appreciation that airmen expressed for the availability of embedded mental health professionals. Airmen also discussed factors that hinder health care-seeking behaviors with the top-reported factor being the stigma associated with seeking mental health. The top three reported factors that encourage health care-seeking behaviors included leadership and mental health professionals normalizing care, trust in embedded mental health professionals, and ease of access to care. CONCLUSIONS: Findings suggest that having mental health professionals integrated within the unit brings the care straight to the airmen and may reduce the stigma associated with airmen asking for help.

The self-reported impacts of the COVID-19 pandemic on psychological health of U.S. Air Force cyber personnel.

U.S. Air Force cyber personnel were faced with changes in their workplace, fitness routines, and personal lives during the COVID19 pandemic. Adjusting to COVID-19-related requirements likely increased the stress of already stressful jobs for military members and their families, which could have resounding impacts on emotional, social, and physical well-being. Therefore, it is important to evaluate psychological health outcomes and self-perceived impacts of the changes presented to cyber personnel because of the COVID-19 pandemic. An online occupational health assessment that included demographics, standardized measures of burnout, psychological distress, and work role strain; health behaviors; and perceived impacts of the COVID-19 pandemic was administered to 1488 cyber personnel. Thirty-two negative themes and 13 positive themes were created from qualitative coding for "How has the COVID-19 pandemic impacted you as an individual?" Of the themes created, 966 (68.5%) reported at least one negative impact and 440 (31.2%) reported at least one positive impact. Top-reported negative impacts were limited face-to-face interactions and loss of personal activities. Negative impacts were associated with negative psychological health outcomes (e.g., psychological distress, exhaustion, cynicism) and work role strain. Action-oriented recommendations are given in the event of another pandemic.

Perspectives of mental health professionals on the delivery of embedded mental health services for U.S. Air Force airmen.

United States Air Force (USAF) leadership implemented the integrated operational support care model, which involves embedding mental health professionals directly within operational units to meet the mental health needs of airmen. The present study evaluated perspectives of embedded mental health professionals on the delivery of embedded care services for airmen assigned to various units and installations. We conducted semistructured interviews with 26 embedded mental health professionals. Interviews were audio-recorded and transcribed verbatim for qualitative analysis, involving thematic content analysis to identify and tabulate key themes emergent from the data. The most commonly reported barriers to delivering embedded mental health services were overcoming stigma associated with seeking mental health care, low staffing, insufficient training, and disconnected relationships between medical treatment facility and other support agencies. Interviewees described numerous strategies for effectively delivering embedded mental health services to include fully understanding and being able to communicate levels of mental health care services, reducing stigma, facilitating coordination of care/resources, and developing initiatives to target population needs. This is the first in-depth, systematic exploration of provider perspectives on embedded mental health services in the USAF. Future research should focus on how best to support embedded care programs to sustain this invaluable service for airmen and other military communities over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Assessing work role strain, burnout, and job satisfaction among remotely piloted aircraft operators: the moderating role of unit social support.

Utilizing the Job Demands-Resources (JD-R) theory as a guiding framework, the current study examined the relationships between job demands (work role strain) and occupational outcomes (burnout and job satisfaction) and assessed how job resources (team member social support and leader social support) mitigated the impact of high job demands for U.S. Air Force remotely piloted aircraft (RPA) operators. A total of 905 active duty U.S. Air Force RPA operators participated in a web-based occupational health assessment. Study findings confirmed that work role strain proved to be strongly related to negative occupational outcomes - increased burnout and reduced job satisfaction. Compelling evidence emerged suggesting that boosting job resources (i.e., team member and leader social support) may be a promising point of intervention to mitigate negative occupational outcomes. By investigating ongoing job demands that result in a higher incidence of burnout and job dissatisfaction, as well as job resources that protect against burnout and job dissatisfaction, researchers and practitioners can continue to introduce supportive resources at crucial points to alleviate the adverse consequences of occupational stress and burnout. Applying the JD-R theory to these findings highlights the importance of job resources for RPA operators and other employees working in high-risk, high-demand career fields. Implications and future directions are discussed.

Effect of the Affordable Care Act on healthcare utilization for Veterans with spinal cord injuries and disorders.

Context/Objective: Provisions of the Affordable Care Act (ACA) potentially increase insurance options for Veterans with disabilities. We examined Veterans with spinal cord injuries and disorders (SCI/D) to assess whether the ACA was associated with changes in healthcare utilization from Department of Veterans Affairs (VA) healthcare facilities.Design: Using national VA data, we investigated impacts on VA healthcare utilization pre- (2012/13) and post-ACA (2014/15) implementation with negative binomial regression models.Setting: VA healthcare facilities.Participants: 8,591 VA users with SCI/D. Veterans with acute myelitis, Guillain-Barré syndrome, multiple sclerosis, or amyotrophic lateral sclerosis were excluded as were patients who died during the study period.Interventions: We assessed VA healthcare utilization before and after ACA implementation.Outcome Measures: Total numbers of VA visits for SCI/D care, diagnostic care, primary care, specialty care, and mental health care, and VA admissions.Results: The number of VA admissions was 7% higher in the post than pre-ACA implementation period (P < 0.01). The number of VA visits post-implementation increased for SCI/D care (8%; P < 0.01) and specialty care (12%; P < 0.001). Conversely, the number of mental health visits was 17% lower in the post-ACA period (P < 0.001). Veterans with SCI/D who live <5 miles from their nearest VA facility received VA care more frequently than those ≥40 miles from VA (P < 0.001).Conclusion: Counter to expectations, results suggest that Veterans with SCI/D sought more frequent VA care after ACA implementation, indicating Veterans with SCI/D continue to utilize the lifelong, comprehensive care provided at VA.

Web-based patient portal use and medication overlap from VA and private-sector pharmacies among older veterans.

BACKGROUND: The availability of Medicare Part D pharmacy coverage may increase veterans' options for obtaining medications outside of the Department of Veterans Affairs (VA) pharmacies. However, availability of Part D coverage raises the potential that veterans may be receiving similar medications from VA and non-VA pharmacies. The VA's personal health record portal, My HealtheVet, allows veterans to self-enter the non-VA medications that they obtained from community-based pharmacies, including those reimbursed by Medicare Part D. The Blue Button medication view feature of My HealtheVet allows veterans to view and download their VA and self-entered non-VA medication history. OBJECTIVE: To examine whether the use by veterans of the Blue Button feature of My HealtheVet was associated with less acquisition of similar medications from VA and community-based pharmacies reimbursed by Medicare Part D. METHODS: This study included a national sample of veterans who were new My HealtheVet users during fiscal year 2013 (October 1, 2012-September 30, 2013) and who used the Blue Button medication view feature of My HealtheVet at least once (users). We compared these veterans with a random sample of veterans who were not registered to use My HealtheVet (nonusers). From these groups, we identified veterans who were enrolled in Part D. We used multiple logistic regression analysis to assess the association of Blue Button medication view use with obtaining medications from the same drug classes (with overlap of 7 or more days) from VA and Part D-reimbursed pharmacies. RESULTS: There were 7,973 My HealtheVet medication view users and 65,985 nonusers. During a 12-month period, medication view users received more 30-day supplies of medications (one 90-day supply equals three 30-day supplies) than nonusers, on average (152.1 vs 71.3, P < 0.001). A larger percentage of users than nonusers obtained medications from VA and Part D-reimbursed pharmacies with overlapping days supply from the same drug classes (30% vs 23%, P < 0.001). However, for veterans who obtained greater numbers of 30-day supplies (82 or more), a significantly smaller percentage of users than nonusers obtained overlapping medications from VA and Part D-reimbursed pharmacies. Moreover, controlling for the total number of 30-day supplies that veterans received, the odds of obtaining medications from VA and Part D-reimbursed pharmacies with days supply that overlapped by at least 7 days for the same drug classes was 18% lower for users than nonusers (P=0.002). CONCLUSIONS: Veterans who used the Blue Button medication view feature of My HealtheVet obtained a larger number of 30-day supplies of medications from VA pharmacies than nonusers. For veterans who obtained a larger number of 30-day supplies of medications, use of the Blue Button medication view feature of My HealtheVet was associated with less overlap in days supply of medication from the same drug class from VA and Part D-reimbursed pharmacies. DISCLOSURES: This study was funded by the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service project IIR 14-041-2. The sponsor provided funding but was not involved in the development of the manuscript. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the Health Services Research and Development Service. All authors are employed in some capacity with the Department of Veterans Affairs and have no conflicts of interest to disclose.

Health-Related Goal Setting and Achievement Among Veterans with High Technology Adoption.

BACKGROUND: There is increasing recognition of the importance of supporting patients in their health-related goals. Patient-provider discussions and health-related mobile applications (apps) can support patients to pursue health goals; however, their impact on patient goal setting and achievement is not well understood. OBJECTIVE: To examine the relationships between the following: (1) patient demographics, patient-provider discussions, and health-related goal setting and achievement, and (2) patient mobile health app use and goal achievement. DESIGN: Cross-sectional survey. PARTICIPANTS: Veterans who receive Veterans Health Administration (VA) healthcare and are users of VA patient-facing technology. MAIN MEASURES: Veteran demographics, goal-related behaviors, and goal achievement. METHODS: Veterans were invited to participate in a telephone survey. VA administrative data were linked to survey data for additional health and demographic information. Logistic regression models were run to identify factors that predict health-related goal setting and achievement. KEY RESULTS: Among respondents (n=2552), 75% of patients indicated having set health goals in the preceding 6 months and approximately 42% reported achieving their goal. Men (vs. women) had lower odds of setting goals (OR: 0.71; CI95: 0.53-0.97), as did individuals with worse (vs. better) health (OR: 0.18; CI95: 0.04-0.88). Individuals with advanced education-some college/college degrees, and post-college degrees (vs. no college education)-demonstrated higher odds of setting goals (OR: 1.35; CI95: 1.01-1.79; OR: 1.71; CI95: 1.28-2.28, respectively). Those who reported having discussed their goals with their providers were more likely to set goals (OR: 3.60; CI95: 2.97-4.35). Patient mobile health app use was not statistically associated with goal achievement. CONCLUSIONS: Efforts to further promote patient-led goal setting should leverage the influence of patient-provider conversations. Use of patient-facing technologies, specifically mobile health apps, may facilitate goal-oriented care, but further work is needed to examine the potential benefits of apps to support patient goals, particularly if providers discuss and endorse use of those apps with patients.

Personality Traits That Distinguish Special Operations Female Aircrew.

INTRODUCTION: U.S. Air Force Special Operations Command (AFSOC) female aircrew represent a small group of military personnel in challenging high-risk, high-demand professions. Personality characteristics may play a key role in distinguishing those women who pursue a career as a special operations aircrew member and succeed in this pursuit. Having access to normative personality data can potentially support psychologists in assessing AFSOC female aircrew and subsequently making informed recommendations to leadership.METHODS: A total of 586 AFSOC aircrew trainees58 (9.9%) women and 528 (90.1%) mencompleted a series of computer-based psychological tests to assess cognitive ability and personality traits.RESULTS: Results indicated significant differences between female AFSOC aircrew and female civilians on four of the five NEO Personality Inventory domains: Neuroticism (M 74.9 vs. M 87.1), Extraversion (M 123.7 vs. M 112.8), Openness to Experience (M 122.6 vs. M 111.0), and Conscientiousness (M 136.0 vs. M 120.6), respectively. The comparison between female AFSOC aircrew and male AFSOC aircrew revealed significant differences across three of the five domains: Neuroticism (M 74.9 vs. M 65.1), Openness to Experience (M 122.6 vs. M 115.0), and Agreeableness (M 119.6 vs. M 112.7), respectively.DISCUSSION: Implications for assessment and interpretation of psychological testing are discussed. This paper provides a unique perspective and insight into those who pursue and excel in this career field. Identifying specific personality traits in our AFSOC female aircrew allows for tailored care and support when evaluating readiness in special operations aircrew for optimizing performance.Chappelle W, Shadle AH, Martinez RN, Reardon LE, Goodman T, Spencer H, Thompson W. Personality traits that distinguish special operations female aircrew. Aerosp Med Hum Perform. 2021; 92(4):240247.

Characterization of Telehealth Use in Veterans With Spinal Cord Injuries and Disorders.

BACKGROUND: Individuals with spinal cord injuries and disorders (SCI/D) require frequent interdisciplinary health care to address impairments in mobility, autonomic function, and secondary complications. Telehealth has the capacity to substantially transform health care delivery and improve care by increasing access and communication. However, relatively little is known about telehealth use in this specific population. Here we attempt to fill part of this gap. OBJECTIVE: To investigate the frequency and characteristics associated with telehealth use in Veterans with SCI/D. DESIGN: Cross-sectional, descriptive project. SETTING: Veterans Health Administration (VHA) facilities. PARTICIPANTS: A total of 15 028 Veterans living with SCI/D who received services from the VHA SCI/D System of Care. INTERVENTION: Not applicable. OUTCOME MEASURES: Frequency and characteristics associated with VHA telehealth utilization. RESULTS: Of the 15 028 Veterans with SCI/D included in the evaluation, 17% used some form of telehealth in VHA Fiscal Year (FY)2017. Veterans older than 65 years of age had lower odds (odds ratio [OR] = 0.88, P < .05, confidence interval [CI] 0.80-0.98) of using telehealth. Being Caucasian (OR = 1.29, P < .01, CI 1.09-1.52), living in rural areas (OR = 1.16, P < .01, CI 1.05-1.28), living greater distances away from the VHA (P < .01 for all distances), and being in priority group 8, meaning that Veterans have higher copayment requirements (OR = 1.46, P < .001, CI 1.19-1.81), were all significantly associated with greater odds of telehealth use. The most frequent types of telehealth used were real-time clinical video and store-and-forward between a provider and patient within the same hub network. CONCLUSION: There are opportunities to increase telehealth adoption in the SCI/D arena. The findings from this project highlight which Veterans are currently using telehealth services, as well as gaps regarding telehealth adoption in this population.

Predictors and protective factors for suicide ideation across remotely piloted aircraft career fields.

The US Air Force remote warrior community comprises several career fields including remotely piloted aircraft pilots and intelligence, cyber, and sensor operators. The crews are responsible for working seamlessly together to provide 24/7 real-time intelligence, surveillance, and reconnaissance and precision-strike weapons capabilities for a wide range of global combat operations. Due to the rapid increase in global demands and operational tempo, there is growing concern from military leadership about the impact of operational stress on the health and psychological well-being of remote warriors. Previous assessments from 2011 and 2015 have demonstrated a significant increase in the reported rates of operators experiencing suicide ideation. The current study examined two protective factors expected to reduce the risk of suicide ideation - team member social support and leader social support. A total of 905 active duty remote warriors participated in occupational health assessments conducted in 2018. Risk factors for suicide ideation included being unmarried, worsening relationship problems, occupational burnout, and increased operational stress. Results indicated that team member and leader social support were significant protective factors for shift workers and those who reported being less likely to seek mental healthcare. Implications of the findings, intervention recommendations, and directions for future research are discussed.

Supporting the Implementation of Connected Care Technologies in the Veterans Health Administration: Cross-Sectional Survey Findings from the Veterans Engagement with Technology Collaborative (VET-C) Cohort.

BACKGROUND: Widespread adoption, use, and integration of patient-facing technologies into the workflow of health care systems has been slow, thus limiting the realization of their potential. A growing body of work has focused on how best to promote adoption and use of these technologies and measure their impacts on processes of care and outcomes. This body of work currently suffers from limitations (eg, cross-sectional analyses, limited patient-generated data linked with clinical records) and would benefit from institutional infrastructure to enhance available data and integrate the voice of the patient into implementation and evaluation efforts. OBJECTIVE: The Veterans Health Administration (VHA) has launched an initiative called the Veterans Engagement with Technology Collaborative cohort to directly address these challenges. This paper reports the process by which the cohort was developed and describes the baseline data being collected from cohort members. The overarching goal of the Veterans Engagement with Technology Collaborative cohort is to directly engage veterans in the evaluation of new VHA patient-facing technologies and in so doing, to create new infrastructure to support related quality improvement and evaluation activities. METHODS: Inclusion criteria for veterans to be eligible for membership in the cohort included being an active user of VHA health care services, having a mobile phone, and being an established user of existing VHA patient-facing technologies as represented by use of the secure messaging feature of VHA's patient portal. Between 2017 and 2018, we recruited veterans who met these criteria and administered a survey to them over the telephone. RESULTS: The majority of participants (N=2727) were male (2268/2727, 83.2%), White (2226/2727, 81.6%), living in their own apartment or house (2519/2696, 93.4%), and had completed some college (1176/2701, 43.5%) or an advanced degree (1178/2701, 43.6%). Cohort members were 59.9 years old, on average. The majority self-reported their health status as being good (1055/2725, 38.7%) or very good (524/2725, 19.2%). Most cohort members owned a personal computer (2609/2725, 95.7%), tablet computer (1616/2716, 59.5%), and/or smartphone (2438/2722, 89.6%). CONCLUSIONS: The Veterans Engagement with Technology Collaborative cohort is an example of a VHA learning health care system initiative designed to support the data-driven implementation of patient-facing technologies into practice and measurement of their impacts. With this initiative, VHA is building capacity for future, rapid, rigorous evaluation and quality improvement efforts to enhance understanding of the adoption, use, and impact of patient-facing technologies.

Developing an animal-assisted support program for healthcare employees.

BACKGROUND: Employee burnout and its associated consequences is a significant problem in the healthcare workforce. Workplace animal therapy programs offer a potential strategy for improving employee well-being; however, research on animal therapy programs for healthcare workers is lacking. This study aimed to evaluate the feasibility, acceptability and preliminary impact of an animal-assisted support program to improve healthcare employee well-being. METHODS: In this mixed-methods pilot intervention study, we implemented an animal-assisted support program in a multidisciplinary healthcare clinic at a large VA hospital. The program included 20 sessions over 3 months, each approximately 1-h long. Real-time mood data were collected from participants immediately before and after each session. Participation rates were tracked in real time and self-reported at follow-up. Data on burnout and employee perceptions of the program were collected upon completion via a survey and semi-structured interviews. Differences in mood and burnout pre/post program participation were assessed with t-tests. RESULTS: Participation was high; about 51% of clinic employees (n = 39) participated in any given session, averaging participation in 9/20 sessions. Mood (on a scale of 1 = worst to 5 = best mood) significantly improved from immediately before employees interacted with therapy dogs (M = 2.9) to immediately after (M = 4.5) (p = 0.000). Employees reported significantly lower levels of patient-related burnout (e.g., how much exhaustion at work relates to interaction with patients) after (M = 18.0 vs. before, M = 40.0) participating (p = 0.002). Qualitative findings suggested that employees were highly satisfied with the program, noticed an improved clinic atmosphere, and experienced a reduction in stress and boost in mood. CONCLUSIONS: Establishing an animal-assisted support program for employees in a busy healthcare clinic is feasible and acceptable. Our pilot data suggest that animal-assisted programs could be a means to boost mood and decrease facets of burnout among healthcare employees.

Did the Affordable Care Act Decrease Veteran Enrollment in the Veterans Health Administration?

BACKGROUND: Provisions of the Affordable Care Act (ACA) provided nonelderly individuals, including Veterans, with additional health care coverage options. This may impact enrollment for health care through the Veterans Health Administration (VHA). National enrollment data was used to: (1) compare characteristics of enrollees at 3 time points in relation to the implementation of ACA insurance provisions (2012); and (2) examine enrollment trends. METHODS: The study population included a 10% sample of Veterans under age 65 who were VHA enrollees between January 2012 and September 2015. Demographic and baseline characteristics were compared between 3 enrollment groups: pre-2012, pre-ACA (2012-2013), and post-ACA (2014-2015). Using an interrupted time series approach, we employed pooled logistic regression to assess trends in new VHA enrollment, overall, and by select enrollee characteristics. RESULTS: A total of 429,833 enrollees were identified. Compared with pre-ACA enrollees, post-ACA enrollees were more likely to be older, have a service-connected disability, live further away from a VHA medical center, but less likely to use primary care within 6 months. The post-ACA quarterly trend in the odds of being a new enrollee was 3% lower (95% confidence interval: 0.96, 0.98) as compared with the pre-ACA trend. This decline was consistent across sex, geography, (all but 1) priority group, and state Medicaid-expansion subgroups. CONCLUSIONS: The ACA appears to have contributed to a decline in new VHA enrollment. In addition, the profile of newer enrollees differs from that of pre-ACA enrollees. The VHA must continue to monitor trends in demand in order to continue delivering high-quality, efficient care.

An ecological perspective on implementing environmental control units for veterans with spinal cord injuries and disorders.

Purpose: Guided by an ecological perspective, the purpose of this study was to identify multilevel factors that influenced the implementation of environmental control units (ECUs) in Veterans Health Administration (VHA) Spinal Cord Injury/Disorders (SCI/D) Centres.Materials and methods: Mixed methods including an online survey and qualitative interviews of VHA healthcare employees.Results: VHA healthcare employees participated in the online survey (n = 153, 21% participation rate) and semi-structured interview (n = 28; 54% participation rate). About 58.2% of survey respondents indicated that patients admitted to a VHA SCI/D Centre received ECU training. Interview participants reported that patients might benefit from educational materials on using ECUs. About 53.7% of survey respondents indicated that they did not receive ECU training. Interview participants emphasized that more healthcare employees needed to be trained to distribute ECU-related tasks including patient training and troubleshooting problems. The most common challenge was the coordination involved in moving patients out of rooms that were being outfitted with an ECU.Conclusions: Application of an ecological framework highlighted a range of factors at multiple levels that dynamically influence ECU implementation while accounting for the SCI/D care context. Integrating this technology with the care experiences of patients, the workflow of healthcare employees, and the structure of the organization may improve the implementation of ECUs.IMPLICATIONS FOR REHABILITATIONAn environmental control unit (ECU) is an assistive technology device that provides persons with a physical disability (e.g., spinal cord injuries and disorders) increased independence in a home, hospital, or rehabilitation facility setting.An ECU allows a person to access and control appliances like their hospital bed, lights, television, doors, nurse call button, telephone, and computer, thus, decreasing workload on attendants and family members while increasing independence for the user.Application of an ecological framework in this study highlighted a range of factors at multiple levels that dynamically influence ECU implementation while accounting for the SCI/D care context.Integrating this technology with the care experiences of patients, the workflow of healthcare employees, and the structure of the organization may improve the implementation of ECUs in an inpatient setting.

How Do Patients with Mental Health Diagnoses Use Online Patient Portals? An Observational Analysis from the Veterans Health Administration.

Online patient portals may be effective for engaging patients with mental health conditions in their own health care. This retrospective database analysis reports patient portal use among Veterans with mental health diagnoses. Unadjusted and adjusted odds of portal feature use was calculated using logistic regressions. Having experienced military sexual trauma or having an anxiety disorder, post-traumatic stress disorder, or depression were associated with increased odds of portal use; bipolar, substance use, psychotic and adjustment disorders were associated with decreased odds. Future research should examine factors that influence portal use to understand diagnosis-level differences and improve engagement with such tools.

Barriers and strategies for coordinating care among veterans with traumatic brain injury: a mixed methods study of VA polytrauma care team members.

BACKGROUND: Veterans who experience traumatic brain injury (TBI) may have long-term needs placing a premium on well-coordinated care. This study aimed to (1) identify barriers to care coordination for Veterans with TBI; and (2) describe strategies used by VA polytrauma care team members to coordinate care for Veterans with TBI. METHODS: We utilised a mixed method design, including an online survey of VA polytrauma care team members (N = 236) and subsequent semi-structured interviews (N = 25). Analysis of the survey data was descriptive; interview data was analysed using constant comparative techniques. RESULTS: The most common system-related barriers 25 for access to military records (64%) and insufficient time (58%). The most common patient-related barriers were missed appointments/no shows (87%) and the mental health issues (74%). Strategies reported on the survey to promote coordination reflected the centrality of teamwork and communication, and included promoting multidisciplinary team collaboration (32%) and holding 30 regular meetings (23%). Interview findings were consistent, emphasising the effective functioning of multidisciplinary clinics. CONCLUSION: Polytrauma care team members encounter barriers to care coordination for Veterans with TBI, and have developed strategies in response. Information sharing, provider workload, communication, and patient engagement will be critical to address in future efforts to enhance care coordination in this context.

Patient perceptions of environmental control units: experiences of Veterans with spinal cord injuries and disorders receiving inpatient VA healthcare.

PURPOSE: To assess patients' perceptions of environmental control units (ECUs) at Veterans Affairs Spinal Cord Injury Centers. MATERIALS AND METHODS: A brief questionnaire was conducted with patients in real-time while they were hospitalised ("on-the-spot questionnaire"); a survey was mailed to patients who had recently been discharged from a hospital stay ("discharge survey"). Data were analysed using descriptive statistics. RESULTS: Seventy on-the-spot questionnaires and 80 discharge surveys were collected. ECU features used most frequently were comparable in responses from both surveys: watching TV/movies (81%, 85%), calling the nurse (68%, 61%), turning lights on/off (63%, 52%), adjusting the bed (53%, 33%), and playing games (39%, 24%). Many on-the-spot questionnaire respondents felt the ECU met their need for independence a great deal (42%). Most respondents to both surveys were satisfied with the ECU (71%, 57%). Areas for improvement included user training, improved functionality of the device and its features, and device design. CONCLUSIONS: ECUs were well-accepted by persons with spinal cord injuries/disorders (SCI/D) in the inpatient setting, and increased patients' perceptions of independence. To maximise usability and satisfaction, facilities should ensure that comprehensive training on ECU use and features available is offered to all patients, and resources are available for timely troubleshooting and maintenance. Implications for rehabilitation An environmental control unit (ECU) is a form of assistive technology that allows individuals with disabilities (such as spinal cord injuries and disorders [SCI/D]) to control functional and entertainment-related aspects of their environment. ECU use can increase functioning, independence and psychosocial well-being among individuals with SCI/D, by allowing users to reclaim control over day-to-day activities that are otherwise limited by their disability. Our study results indicate that, among persons with SCI/D, ECUs are well-accepted and increase perceptions of independence. To maximise usability and patient satisfaction, facilities should ensure that comprehensive training on how to use ECUs and what features are available is offered to all patients, and resources are available for timely troubleshooting and maintenance.

A Mixed-Methods Study of Veterans Affairs Providers' Experiences Communicating With Patients About the Affordable Care Act.

OBJECTIVE: The provisions under the Affordable Care Act (ACA) can potentially increase insurance options for Veterans. Veterans must be informed about their options, and potential benefits and challenges associated with use of multiple health care systems. This study aimed to assess VA providers' perceptions of how they contributed to Veterans' health care decision-making within the health care context established by the ACA. MATERIALS AND METHODS: A mixed-methods approach including an online survey and semi-structured interviews was used to assess the experiences of health care providers (e.g., physicians, nurses, and social workers) communicating with Veterans about the ACA. Closed-ended survey questions were analyzed using descriptive statistics. Qualitative analysis of open-ended responses to the survey and semi-structured interview entailed thematic analysis, which involved identifying themes and patterns within and across participants until reaching saturation. RESULTS: A total of 251 providers completed the survey (20% response rate), and 26 providers completed a semi-structured interview (23% participation rate). Most providers (75.3%) reported being only "a little" or "somewhat" knowledgeable about the overall provisions of the ACA, and 90.8% of providers reported needing more information about the ACA. Key themes that emerged from the qualitative analyses included a variety of issues related to the ACA. According to providers, Veterans raised concerns about: signing up for the ACA, retaining VA benefits, knowledge about VA benefits and the ACA, understanding implications of insurance coverage through the ACA, and affordability of the ACA. Providers expressed the need for provider and patient educational resources. CONCLUSION: Our findings suggest that Veterans and their providers encounter challenges comprehending recent policy changes and navigating ongoing dual health care use. According to providers, Veterans' knowledge about the ACA can affect their ability to make informed health care decisions. Equipping patients and providers with more information about the ACA, and promoting communication between patients and providers may foster shared decision-making processes with regard to health care and treatment options. Strategies to improve knowledge transfer and patient-provider communication about policy changes warrant further investigation.

Sociotechnical Perspective on Implementing Clinical Video Telehealth for Veterans with Spinal Cord Injuries and Disorders.

BACKGROUND: Real-time videoconferencing technology such as clinical video telehealth (CVT) offers a means to reach patient populations who face limited access to healthcare. The Veterans Health Administration has invested in CVT to improve care access for U.S. military veterans with spinal cord injuries and disorders (SCI/D); however, no studies have assessed the factors that influence implementation of this technology in clinical practice for individuals with SCI/D. INTRODUCTION: Guided by a sociotechnical perspective, the purpose of this study was to identify factors that influence implementation of CVT for veterans with SCI/D. MATERIALS AND METHODS: We conducted semistructured telephone interviews with 40 healthcare providers who use CVT to deliver services to veterans with SCI/D. RESULTS: Factors related to workflow and communication were widely reported as implementation barriers. Coordinating logistics for CVT appointments was challenging, and effective communication between CVT team members across facilities was considered crucial. Providers also cited factors related to technical infrastructure, people, and organizational features, including the need for appropriate equipment, space, personnel, and support for using CVT equipment. DISCUSSION: The implementation of CVT in the care of veterans with SCI/D was influenced by an interrelated set of social and technical factors. Key among them were social factors related to people, workflow, and communication, given that CVT supports healthcare teams interacting remotely in real time. CONCLUSIONS: CVT implementation requires teams working together to negotiate a complex, distributed process across multiple sites. Such complexity places a premium on teamwork and communication among healthcare teams before, during, and after a CVT encounter.

Evaluation and Treatment of Mild Traumatic Brain Injury Through the Implementation of Clinical Video Telehealth: Provider Perspectives From the Veterans Health Administration.

BACKGROUND: Substantial numbers of U.S. military veterans who served in recent conflicts experience mild traumatic brain injury. Data suggest that as many as 25% of veterans do not have a comprehensive traumatic brain injury evaluation to determine a diagnosis and develop a plan to treat symptoms. Technologies like clinical video telehealth offer a potential means to overcome travel distance and other barriers that can impact veteran receipt of a comprehensive traumatic brain injury evaluation after a positive screening; however, little is known about implementing clinical video telehealth in this context. OBJECTIVE: To examine the perspectives of Veterans Health Administration health care providers on implementing clinical video telehealth technology for the assessment and treatment of mild traumatic brain injury among veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. DESIGN: Qualitative; semistructured interviews. SETTING: Veterans Health Administration Polytrauma System of Care. PARTICIPANTS: Twenty-six providers who participated in a Veterans Health Administration Rehabilitation and Prosthetic Services Teleconsultation Pilot Project for administering comprehensive traumatic brain injury evaluations over clinical video telehealth. METHODS: Semistructured interviews that used content-analytic techniques to assess provider experiences implementing clinical video telehealth for veterans with traumatic brain injury, including inhibiting factors and best practices to administer comprehensive traumatic brain injury evaluations. RESULTS: The most commonly reported inhibiting factors to implementing clinical video telehealth for traumatic brain injury evaluation and treatment included scheduling, setting up the clinic, and conducting physical examinations over a virtual modality. To enhance clinical video telehealth implementation, participants described best practices including establishing solid communication and relationships with staff, building rapport with patients, and recognizing the unique needs of patients with traumatic brain injury. CONCLUSIONS: Implementing clinical video telehealth programs involves coordinating multiple steps with providers at different sites, highlighting the need for effective communication. Provider-patient communication also emerged as vital to successful clinical video telehealth implementation. These findings suggest that providers would benefit from efforts to build communication competencies. LEVEL OF EVIDENCE: Not applicable.