Rural and Non-Rural U.S. Veterans Receiving Virtual Geriatric Mental Health Services in the Clinical Resource Hubs.

Abstract

Objective: Veterans Health Administration Clinical Resource Hubs are regional telehealth hubs that provide Veterans access needed to geriatric mental health (GMH) services without long drive times to urban centers to find specialists. This analysis characterized the GMH telehealth services to examine differences between rural and non-rural Veterans.

Methods: Electronic health record data were extracted (October 2021 to September 2023) for encounters delivered by telehealth GMH teams staffed by geriatric psychiatrists, pharmacists, geropsychologists, and neuropsychologists. Variables included Veteran demographics, diagnoses, severity of care needs, services delivered and visit modality. Descriptive statistics, chi-square and t-tests summarized the data and examined rural and non-rural differences.

Results: GMH clinicians completed 9282 encounters with 2013 Veterans (Mean age = 75.8). Most services were video to home (48.2%) followed by video to clinic (25.4%), and phone (22%) with no differences in service delivery modality among rural and non-rural Veterans. Rural Veterans had a higher proportion of psychotherapy and dementia-related services, and lower proportions of medication management and services for depression, anxiety, and serious mental illness compared with non-rural Veterans.

Conclusions: Older Veterans access virtual GMH care for a wide range of mental health and cognitive disorders. The apparent higher utilization of psychotherapy and dementia services for rural compared with non-rural Veterans may relate to barriers to obtaining these services locally, although it may be partially explained by variations in virtual team compositions and settings served.

Relevance to clinical practice: This evaluation suggests high acceptability of video-delivered care for older, rural Veterans with high care needs.