Article

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.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS