ABSTRACT
Background: In April 2020, the Montana Geriatric Workforce Enhancement Program (MGWEP) applied for CARES Act funding to use telehealth to prevent, prepare for, and respond to COVID-19. As a GWEP based in a College of Health with limited clinical facilities, MGWEP turned to its community partners to pursue this opportunity. The program ended April 30, 2020, and 18 months later MGWEP queried its partners to determine the sustainability of their projects. Methods: A qualitative scripted telephone interview was used to determine the status of the telehealth projects. Each partner was asked about barriers to continuation, changes in project partners, funding, and individuals served. Results: Five of the six projects are ongoing 18 months after the funding ended. Missoula Aging Services' Lifelong Connections provides wifi-enabled tablets, instruction and support to older adults to engage in telehealth and other uses. Ten participants have been added with plans to expand into rural areas;new partners added funding. Skaggs School of Pharmacy secured additional funding to continue use of a simulated EHR platform, training interdisciplinary student teams in a virtual environment. An additional 99 students and 21 instructors have participated in these events. MGWEP's two CHC partners used the funding to support the successful implementation of telehealth visits in their clinics. While the demand for telehealth medical visits has declined, the technology is still being used in behavioral health. The Montana Alzheimer's Association utilized the funding to engage 5 long-term care communities in Project Vital;each site received 2 wifi-enabled tablets for use by their residents. Three sites continued into a second year, but staffing issues may prevent continuation of the program. Mountain-Pacific Quality Health, Montana's QIO, attempted to recruit and train telehealth patient navigators to assist older adults. MPQH developed training materials but had difficulty recruiting individuals to complete the remote training. The project was discontinued after the MGWEP funding ended. Conclusions: MGWEP had difficulty responding to the funding opportunity on short notice and with no direct access to clinical facilities. Our partners provided such access, but led to the question of sustainability of multiple projects. Four are successful with ongoing funding, one moderately so, and one did not continue. Depending on future opportunities that arise, MGWEP plans to involve its community partners.
ABSTRACT
Background: The COVID-19 pandemic necessitated initiation of telehealth visits between patients and providers for the safety and convenience of both parties. RiverStone Health (RSH), a FQHC, had not performed telehealth visits prior to spring 2020. RSH is a community health center located in Billings, MT, with several rural satellite clinics. As the pandemic developed, a needs assessment was performed to determine the interest and needs of older adult patients to engage in telehealth. Methods: RSH identified 1,140 patients age 65 or older, 817 in the main clinic and 323 in rural clinics. A 13-question survey was devised with a goal of completing it with 300 patients by phone in fall 2020. 716 calls produced 303 completed surveys, 257 from the main clinic and 46 from rural clinics. Six individuals made calls, recording the responses in a data base. Questions included interest in telehealth, capability to participate, need for training and equipment, and interest in Zoom sessions for education and socialization. Results: Ten percent of patients surveyed had completed a telehealth visit and 41% were interested in doing so. Capability to participate in a visit included having internet access (35%) and either a computer (25%) or an iPad (29%). While 20% had participated in communication via an electronic platform (Skype, FaceTime or Zoom), 18% felt they would need training to participate in telehealth visits. Similarly, 18% indicated that they had someone to assist with such as visit, and 14% thought a close family member would need training. Only 14% were interested in the loan of an iPad. Interest in Zoom sessions for socialization (14%) and education (17%) was also determined. Conclusion: When the percentages obtained in this survey are extrapolated to the patient population age 65 or older, almost 500 clinic patients were interested in a telehealth visit, and up to 160 patients would need the loan of an iPad. With funding from the CARES Act, RSH has been able to purchase 10 iPads and develop an infection control procedure. When a patient indicates interest in a telehealth visit and needs an equipment loan, this information is saved in the EMR for future visits. RSH is also planning to follow up with those patients interested in Zoom sessions for education or socialization.
ABSTRACT
Background: Interprofessional Student Hotspotting addresses patients with complex medical and social needs. In 2015, Johnson et al found that 82% of these patients have multiple comorbidities, 41% have a serious mental health condition, and 30% report homelessness. High utilization patients have four times more inpatient admissions, four to eight times more readmissions, 30% longer and more expensive hospital stays than the average patient. Our project, a collaboration between the Camden Coalition, University of Montana, Montana Geriatric Education Center and Partnership Health Center, aims to decrease emergency department (ED) visits and increase primary care engagement. By using student teams, we aim to increase understanding of interprofessional collaborative practice (IPCP). Methods: Through home-based, non-clinical interventions to address social determinants, teams worked for 6 months to improve patients' quality of life, integrate medical, behavioral, and social care, and increase utilization of primary care. At the onset of COVID-19, faculty determined that ending services for these vulnerable older adults could be determinantal. Thus, students continued the program in a virtual format through mid-June. Patient utilization of the ED and primary care and PHQ-9 depression scores were monitored before, during and after program participation. The student outcomes were assessed using the Student Perception of Interprofessional Clinical Education - Revised (SPICE-R). Results: Patients decreased ED utilization, increased appropriate use of primary care, and improved depression scores. During the first months of the pandemic, patients in the virtual hotspotting increased their comfort in using technology for medical appointments as well as engaging in online social interactions. The students improved their understanding of and skills for IPCP as demonstrated by increased SPICE-R scores. Conclusion: Student Hotspotting is an educational tool to support IPE and training in patient-centered care while improving health outcomes and decreasing healthcare expenditures in patients with high utilization.