Shiv Lamba
Sandra Garcia, Stuti Dang
Abstract
Background:
The VA cares for older high-risk Veterans who are at a risk for institutionalization. Their care requires the use of home- and community-based services and supports. Yet, current systems of treatment delivery too often fail to meet the needs of these high-risk Veterans. This discrepancy in need and available services presents an opportunity for a new innovative program to bridge the gap in improving care for these HNHR veterans. A promising approach to address these barriers has been the use of Peer Support Specialists (Peers). Peers are veterans hired by the VA to help other veterans engage in their treatment successfully. Peers promote recovery by using their common bond of being veterans and sharing their own recovery stories.
The Peer-2-PACT (P2P) was a peer-led, home-visit needs assessment intervention for high-need high-risk older veterans and implemented peers as home extensions of VA primary care Patient-Aligned Care Team (PACT), for targeted data gathering to link HNHR Veterans to needed services. P2P aims to expand the capacity of the VA to deliver PACT integrated, Veteran-partnered access to needed services and supportsto high need high risk older adults.While the peers also do in person home visits, this preliminary analysis evaluates the value of video-home visits to identify unmet needs.
Methods:
We hired two Peers who helped pilot the intervention in Miami VA.Peers acted as a primary care extension to assist health improvement via targeted data gathering, virtual and home visits, and patient engagement through 1:1 counseling and motivational interviewing, and linkinghigh-risk veterans to needed services.
The peers were trained in whole health principles and motivational interviewing. The peers performed a checklist-guided assessment of patient needs virtually using the home visit checklist.Peers were able to use video visits to conduct a virtual visit with the patient, gather data on unmet needs, look for home safety concerns, and medication list management. The peers use the information to assist the patient and the primary care team with care coordination, health education and navigation.
Results:
Eight initial video-visits have been successfully completed among the patients who were offered virtual visits, and a few follow up visits. The average age of the video visit participants (n=8) was 74±9.0; white 4(50%); males (100%). The most common needs identified were home safety devices needed 5(62.5%); housing assistance 2(25%), help with scheduling appointment 2(25%), and medication refills 2(25%). The peers say that depth assessment was the main deficit via video-visits.
Conclusion:
This study is ongoing, but preliminary data show that video-home visits by peers may be a promising and innovative way to identify and address the unmet needs of high-risk older adults if they are able to participate in a video visit. The P2P video home visit component helped identify unmet needs. Qualitative feedback from peers and providers has yielded positive comments. We will conduct evaluation of these activities using implementation framework and mixed-methods techniques and get feedback from patients, caregivers, peers, and other stakeholders.