Patient reflections on benefits, challenges, and improvement opportunities for a VA podiatry telehealth program: a qualitative study.

Introduction: Within the Department of Veterans Affairs (VA), the High-risk Eye and Limb Preservation Program (HELPP) delivers basic foot care using telemedicine and remote technology to prevent Veteran limb amputation. To enable basic foot care delivery in rural locations, HELPP hires intermediate care technicians (ICTs) to perform foot care under the tele-supervision of a podiatrist. This evaluation aimed to understand HELPP benefits, challenges, and improvement opportunities based on patients' experiences. Methods: As part of a program evaluation, patients who had received HELPP care were invited to participate in semi-structured interviews informed by the RE-AIM framework to assess patient-experienced benefits and challenges with HELPP and identify improvement opportunities. Rapid analysis was performed using summary templates and an analytic matrix. Results: Twenty-one interviews were completed. Benefits included staff quality, increased convenience and accessibility, and improved and maintained foot health. Challenges included ICT turnover and the resulting issues with variability in communication and care quality, the podiatrist not being in-person, and scheduling issues. Patients' improvement suggestions focused on connecting more Veterans to care and follow-up care. Discussion: Overall, the patients interviewed were satisfied with their HELPP care and identified several benefits; however, patients also spoke to challenges and improvement opportunities that should be considered for HELPP expansion and sustainability. Notably, patients often spoke of staff quality and effect of staff turnover, highlighting the importance and visibility of staffing in telemedicine care.