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Veterans Health Administration

Rural Health: A Health Frontier

Two women sitting in front of a TV

U.S. Air Force Veteran Brianna Brown, of Baggs, Wyo., and VA registered nurse April Branstetter participate in a video conference between the Craig Colorado TeleHealth Clinic and representatives at the VA Denver Regional Office.

“Within a 15 mile drive [and] a 2,500 foot elevation gain, sits a small community the medical center serves. In good weather this would be a 25 minute drive, but in a heavy snowstorm this drive could take more than an hour or make it almost impossible to get here.”

For Pam Schultz and her coworkers at the Grand Junction, Colo. VA Medical Center, it’s the bad winter weather and long distances that require their rural health program to be flexible and prepared for any situation.

The Grand Junction VA Medical Center’s rural health care teams want Veterans to know that a key part of their health care is accessibility. It’s not worth the risk driving to the VA in bad weather or in an emergency.

“With the technology we have, the future is really bright. The Veterans are learning from each other about the better access and as long as there is funding, that will continue.”

— Mary Lasley, physician assistant at the
Grand Junction VA Medical Center

The Rural Health Program provides health care accessibility with a home-based primary care team that covers a 60-mile radius. There are three TeleHealth Clinics plus contract clinics and rural hospitals.

Erasing the Distance

In the Rural Health Program, technological advancements have removed distance as a barrier to most aspects of routine care. For example, annual physicals can now happen with the patient and primary care provider teleconferencing from hundreds of miles apart.

“We can check a knee for swelling. We have a close-up camera to look at skin lesions and at the ear, nose, and throat. We have a stethoscope hooked up to headphones,” says Mary Lasley, a physician assistant at the Grand Junction VA Medical Center.

Lasley works with Veterans at the Glenwood Springs TeleHealth Clinic which is 80 miles from the Medical Center. Along with the clinics in Craig, Colo. and Moab, Utah, TeleHealth offers not only primary care services but also mental health appointments, patient education, and nutritional counseling.

When something more complex is needed, the Veterans need to drive to the medical center. To make the medical center visits shorter, routine procedures such as blood tests or a referral can be done at the TeleHealth clinic in advance.

Pam Schultz works as the director of the Home-Based Primary Care program. The program provides primary care by an interdisciplinary team in the home of Veterans who have a difficult time getting into the medical center for appointments.

The team uses Care Coordination/Home TeleHealth to help deliver vital information over the phone between the Veteran and care coordinators. Veterans can enter their vital signs such as blood pressure or blood sugars and care coordinators can use the information to monitor the Veterans’ health.

An important part of the home visits involves educating the veterans on emergency preparedness. Staff train the veteran to collect the “phone numbers of their electrical company, oxygen supplier and alternate caregivers, and teach them about emergency supplies to have on hand.” says Pam Schultz.

The medical center’s pharmacy is also prepared to provide and arrange for medications in all situations.

“Our focus is the patient. We do whatever we can to help that individual to obtain whatever they need. Their needs may very well be different: urgent, non urgent or just needing education,” says Nanette McNees, chief of Grand Junction’s Pharmacy.

If the situation is not urgent, they will normally mail prescriptions to Veterans. In an urgent situation, McNees and her staff will use a network of emergency providers for rural veterans.

Word of Mouth

Veterans find out about rural health services through VA’s outreach efforts at community events, health care providers and local service organizations. They also find out through traditional word of mouth.

“Our program has spread like wildfire because our Veterans tell other Veterans. Those Veterans come in and say I heard from so-and-so. We have had such an influx, because it is word of mouth,” says social worker Lisa Strauss, the Grand Junction VA Medical Center’s Homeless Care Coordinator.

Strauss says that while the Grand Junction area may not have the same resources as large, urban areas, they do have quality services. Community partners work together to direct Veterans to the assistance.

Strong communication also helps with arranging care between the specific rural health programs and regular VA care.

Grand Junction VA Medical Center Patient Advocate Tim Johnson helps coordinate the time rural Veterans spend traveling to and from the medical center. If a Veteran has several upcoming appointments, and a two- to five-hour drive in the winter, they try to make sure that all are on the same day.

“We do much better with everybody talking. [For example,] if they live near a TeleHealth clinic, they can get their blood drawn a week early so their results are available by the time they get to the [medical center],” says Johnson.

Increased Accessibility

Plans are underway to use technology to offer more TeleHealth services from even more distant VA medical centers like Denver. The medical center’s program is also expanding with a second Home-Based Primary Care team.

“With the technology we have, the future is really bright. The Veterans are learning from each other about the better access, and as long as there is funding, that will continue,” says Mary Lasley.

In the midst of technological advances and expansion, the Grand Junction VA Medical Center team will continue to offer adaptable and accessible care for all Veterans.

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