Chronic Disease Management for Recently Homeless Veterans

Abstract

Background Though vulnerable populations may benefit from in-home health information technologies (HIT) that promote disease self-management, there is a “digital divide” in which these groups are often unlikely to use such programs. We describe the early phases of applying and testing an existing Veterans Administration (VA) HIT care management program, Care Coordination Home Telehealth (CCHT), to recently homeless Veterans in the U.S. Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program. Peers were used to support patient participation. Methods CCHT uses in-home messaging devices to provide health education and daily questions about clinical indicators from chronic illness care guidelines, with patient responses reviewed by VA nurses. Patients could also receive adjunctive peer support. We used medical record review, Veteran interviews, and staff surveys to “diagnose” barriers to CCHT use, assess program acceptability, explore the role of peer support, and inform future quality improvement. Subjects Fourteen eligible Veterans in HUD-VASH agreed to CCHT participation. Ten of these Veterans opted to have adjunctive peer support and the other four enrolled in CCHT usual care. Results Though barriers to enrollment/engagement must be addressed, this subset of Veterans in HUD-VASH was satisfied with CCHT. Most Veterans did not require support from peers to engage in CCHT but valued peer social assistance amidst the isolation felt in their scattered-site homes. Conclusions HIT tools hold promise for in-home care management for recently housed Veterans. Patient-level barriers to enrollment must be addressed in the next steps of quality improvement, testing and evaluating peer-driven CCHT recruitment.

Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis

“…Satisfaction was directly related to the participant’s perceived relevance of the tools and the level of positivity in the relationship with the intervention provider. In two studies,30 31patients expressed high levels of satisfaction from their interaction with nurses, which promoted better understanding of their condition. Others showed high levels of willingness among patients to use telemonitoring equipment (95%) and recommend it to others (90%) or pay for telehealth services32 and a sense that equipment helped them to monitor and improve their health 33…”

Experts by Experience: Peer Support and its Use with the Homeless

“…The search process refined the research question to examine the effectiveness of IPS with a homeless population. The search also revealed that IPS is currently being used with the homeless for various health interventions: TB, HIV, overdose prevention, and Hepatitis (Gabrielian et al 2013 ; Tulsky et al 2000 ; Wright et al 2006 ).…”

“…Peers are currently aiding the homeless with health management, medication regimes, and acting as buffers for professionals (Deering et al 2009 ; Fogarty et al 2001 ; Gabrielian et al 2013 ; Pilote et al 1996 ; Rice et al 2012 ; Tulsky et al 2000 ). The literature examining the efficacy of this practice has been mostly supportive; various studies report that peers can help to reduce hospital admissions, relapses, increase coping skills, and improve overall quality of life for those with mental illness (Davidson et al 2006 ; Salzer 2002 ; Solomon 2004 ; Wallcraft et al 2003 ).…”

Health Service Access Among Homeless Veterans: Health Access Challenges Faced by Homeless African American Veterans

“…In one study, 89 percent of veterans had a mobile phone and health was the second most common reason for using their phones [ 108 ]. For recently housed veterans, in-home health information technologies—including the Care Coordination Home Telehealth (CCHT) program—hold promise for closing some of the Availability gaps for veterans managing chronic illnesses [ 109 ].…”