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Thursday, July 30, 2020

By Craig Anderson

 

WILMINGTON, Del. (AP)—Walk-in health care options remain for veterans, but they're the path far less traveled as the COVID-19 pandemic continues.

There's been a seismic shift from offices toward telehealth—video to home services—at the Wilmington VA Medical Center (WVAMC) and across the nation, officials say.

From Oct. 1, 2019 to June 30, 2020, virtual visits in Wilmington through VA Video Connect skyrocketed 922.26% from the same previous 12-month time frame, rising from 844 appointments to 8,403.

“Although we initially limited visits and procedures to essential care (when the coronavirus arrived), we performed an unprecedented number of telehealth/virtual care visits,” WVAMC Chief of Staff Dr. George Tzanis, MD, said.

U.S. Army veteran David Smyth, who served as a police officer before receiving an honorable discharge in 1993, joins his doctor weekly on a video conference, and prefers not to navigate the smallish VA parking lot any time soon.

“If it's OK with my doctor I don't feel the need to meet in person for now,” the Hockessin resident said Thursday.

And regarding the burgeoning surge to telehealth services, Mr. Smyth said, “They're really on top of it.

“The Wilmington VA before COVID made it very clear they cared a lot about veterans and nothing about that has changed.

“In fact, in some ways, they are trying even harder.”

The medical center's emergency department, inpatient care and Community Living Center have remained open as well. Ultimately, physicians and treatment teams have discretion on needed face-to-face interactions, officials said.

“During this pandemic, we have encouraged all veterans to not delay essential care,” WVAMC Director Vince Kane said.

“We were proactive in our outreach to contact veterans with medical histories of heart disease, breathing problems, diabetes and hypertension to contact us to maintain their treatment regimen.”

Also, “We use home blood pressure monitoring, thermometers, scales and oximeters to help do some things, but any examination that relies on touch or a diagnostic testing or involves significant risk should be done in person,” Dr. Tzanis said.

While staff training has been needed for technological operations, Mr. Kane said, “We were prepared for this prior to the pandemic because we routinely rely on telehealth during inclement weather. More than 90% of staff had done virtual care in most clinical areas. We allowed staff to work from home, which was new, but everything else was an established crisis response.”

Through telehealth, according to Mr. Kane, the capacity to address a higher volume of cases has evolved.

“This has been a better economical use of time for veterans and our facilities as veterans can get care from the comfort of their homes, and we can see more patients,” he said.

Telephone and video care are especially effective for behavioral health matters, Dr. Kane said, “Blood pressure monitoring is probably better done at home if the patient has a working cuff.

“And much of the routine care we provide for established patients can be done.”

 

GETTING MORE COMFORTABLE

As veterans have migrated to virtual visits they've “gotten more comfortable and their feedback has been overwhelmingly positive, which has led to such a dramatic increase of use without compromising quality,” Mr. Kane said.

Also resolved technological issues such as bandwith interruption have allayed concerns, Dr. Tzanis said.

According to Connected Care Coordinator/Nurse Manager Michael Selby, “When the system is interrupted, it does cause customer anxiety for both the veteran and clinicians.

“However, Wilmington's Connected Care staff do a great job of providing internal customer service recovery, by being a reinforcement to national helpdesk and giving our patient population and clinicians a resource for immediate assistance.

“This has helped to convince veteran and clinicians this alternative can be beneficial. It also helped the Medical Center to be prepared during the initial impact of the pandemic; as well as any anticipated trends the pandemic's status that could continue to affect traditional care delivery.”

Now, Mr. Selby said, “Virtual care will be a part of the new normal; continuous improvement will only ensure sustainment.”

While there's no completely replacing face-to-face care, Mr. Selby maintained that “The goal of the telehealth medium is to ensure continuity and provide clinical care under the least exposure to the patient related to vulnerability during COVID-19.

“Use of the telehealth medium for any modality is clinician driven, so we are always looking at best practices . to determine what can be adopted at WVAMC for optimal success.”

Veterans with no online access or opting not to utilize virtual care can schedule in-person care visits by calling 1-800-461-8262 and selecting Option 2.

A VA-issued iPad is also available, along with telephone consultations.

Veterans visiting WVAMC facilities must wear face coverings or masks and notify or health care need beforehand by calling 1-800-461-8262 and selecting Option 2. Walk-ins are discouraged and scheduled care preferred.

Information about VA's telehealth services is available online at connectedcare.va.gov.