Rural Veteran perceptions of a virtual health resource center in a community-based setting

Abstract: Background: Virtual care (VC) services (e.g., telemedicine) could help address transportation barriers to healthcare among rural Veterans. The Veterans Health Administration (VA) Virtual Health Resource Centers (VHRCs) provide in-person and telephone technology support for Veterans to use VC, but few are in rural locations. Our objective was to understand Veteran perceptions of a novel implementation of a rural, community-based VHRC. Methods:We conducted our study using an established learning health system model and a rapid qualitative analysis approach to collect and analyze data. Data were abstracted from the VA Corporate Data Warehouse to create a recruitment sample of 200 Veterans with diverse characteristics (i.e., race/ethnicity, gender), half of whom had no video visits within the last 3 years to compare groups across VC use. We developed a semi-structured interview guide using pre-determined constructs from an adapted conceptual model for healthcare access. We conducted interviews virtually. We used template analysis to analyze data. Results: We interviewed 28 Veterans; 57% interviewed had used video visits, 27% identified as a race/ethnicity other than non-Hispanic white, and 26% identified as female. Almost all Veterans interviewed said that the proposed site was easy to get to and most viewed VHRC services favorably. In terms of intervention adaptations, Veterans suggested expanding VHRC services to highly rural communities and on-site add-on services (e.g., labs, EKG) to supplement VC. Veterans also discussed a recently closed VA clinic in the town of the planned implementation and perceived the VHRC as replacement for services lost. Conclusion: Rural Veterans were receptive to a community-based implementation of a VHRC alongside a mobile medical unit. This implementation strategy could allow for expanded clinical services, mobile services to highly rural sites, and address services lost from a recent clinic closure. Our findings could help guide rural VHRC and innovative digital access services implementation broadly.

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