Date Presented 03/27/20
Little is known about utilization of video telehealth with older clients by OT practitioners. Of 322 OT practitioners at the Veterans Health Administration participating in a web-based survey, 41% use video telehealth with older clients. The primary facilitator reflected practitioner attitudes, while the primary barrier was institutional. Findings highlight key person-level and system-level factors in implementation of video telehealth for older clients.
Primary Author and Speaker: Megan Gately
Additional Authors and Speakers: Tickle-Degnen Linda, Keren Ladin, Lauren Moo
Contributing Authors: Ward Nathan
PURPOSE: Telehealth is an emerging practice area within occupational therapy, with the potential to increase client access to services. Video telehealth is a live, synchronous encounter in which client and provider are in two separate locations. Barriers to video telehealth for occupational therapy providers include laws and regulations governing telehealth, which vary greatly state-to-state. This study examines current adoption of video telehealth by occupational therapy practitioners at Veterans Health Administration (VHA), a forerunner in telehealth.
DESIGN: Descriptive survey and exploratory descriptive analysis.
METHOD: A survey was created, employing subject matter experts in geriatrics and telehealth both inside and outside VHA. The survey was piloted with five occupational therapy practitioners. Questions examined demographics, practice patterns and populations served, current and planned utilization of video telehealth, and implementation barriers and facilitators. Barriers and facilitators represented either individual-level factors, such as attitudes and openness, or institutional factors, such as leadership support and available equipment. VHA occupational therapy practitioners (occupational therapists and occupational therapy assistants) were invited to participate in a voluntary web-based survey using VHA REDCap via internal email distribution lists and posts to the occupational therapy site on the VA’s virtual media group. The survey was open for four weeks and practitioners received three email reminders. Descriptive statistics summarized survey findings.
RESULTS: Of approximately 1500 VHA practitioners, 322 practitioners, mostly occupational therapists (96%), participated in the survey. Most practitioners were white and female. Of the 96% who reported treating older clients, 41% report using video telehealth with them. Of those not using video telehealth, 59% report willingness to utilize video telehealth. The primary reported facilitator was person-level, “Willingness to try new approaches,” while the primary reported barrier was institution-level: “Inadequate space, physical location and/or related equipment.”
CONCLUSION: Although fewer than half of surveyed VHA occupational therapy practitioners treating older clients use video telehealth with this population, most of those not yet using video telehealth are willing to. While practitioner attitudes were a facilitator, institutional factors were an implementation barrier. VHA has been a pioneer in telehealth, allowing for telehealth practice across states lines. By leveraging VHA’s experience as an early adopter, these survey findings help to identify potential barriers and facilitators to implementing video telehealth by occupational therapy practitioners in other health care systems.
IMPACT STATEMENT: With the increasing push to integrate virtual care delivery strategies into health care, and the need to better define occupational therapy telehealth practices, these findings add to the evidence base by highlighting practitioner attitudes and infrastructure needs as important for successful integration of video telehealth into practice.
References
American Occupational Therapy Association. (2018). Telehealth in occupational therapy. Am J Occup Ther, 72(Supplement_2), 7212410059. Retrieved from: https://doi.org/10.5014/ajot.2018.72S219.
Bopp. A. (2019, October 30). House and Senate legislation would allow OT providers to offer therapy via telehealth. Retrieved from: https://www.aota.org/Advocacy-Policy/Congressional-Affairs/Legislative-Issues-Update/2019/Bicameral-Telehealth-Legislation-Introduced.aspx.
Tuckson, R.V., Edmunds, E., & Hodgkins, M.L. (2017). Telehealth. New England Journal of Medicine, 377, 1585-1592. doi: 10.1056/NEJMsr1503323.
Bierman, R. T., Kwong, M. W., & Calouro, C. (2018). State occupational and physical therapy telehealth laws and regulations: A 50-state survey. International journal of telerehabilitation, 10(2), 3–54. doi:10.5195/ijt.2018.6269.
