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COVID 19 Conference

Organization and implementation of telehealth due to the COVID 19 pandemic in a VA chiropractic clinic: A descriptive report

By: Valerie Johnson, DC, Enya Katz, DC,Celeste Holder, DC of VA Greater Los Angeles Healthcare System (VAGLAHS), Chiropractic Department, Physical Medicine and Rehabilitation amd Robb Russell, DC of VAGLAHS and Southern California University of Health Sciences 

Background

With the exponential spread of COVID-19, the chiropractic department at VAGLAHS was tasked with rapidly transitioning to telehealth as the predominant form of patient care telehealth services were in use at VAGLAHS prior to COVID 19 but had not been employed by the chiropractic department. 

Figure 1. Telehealth by telephone

Purpose

The purpose of this study is to describe the rapid implementation of telehealth by the chiropractic clinic using real-time video conferencing and phone calls for chiropractic services at facilities operated by VAGLAHS. 

Methods

This is a retrospective description of chiropractic clinic operations within Physical Medicine and

Rehabilitation at VAGLAHS As a descriptive report of the transition from in-person care to telehealth at VAGLAHS, it does not include information on human subjects and does not require Institutional Review Board approval. 

Organizing for Telehealth

Before implementing telehealth services, chiropractic clinical staff met to create templates for electronic health records, complete telehealth training, and order equipment Support staff notified patients of the option for telehealth visits and cancelation of in-person visits.

Practical Implementation of Telehealth 

Prior to acquiring cameras and microphones, initial telehealth visits were conducted by phone (Figure 1).  Subsequently, video or phone visits were offered depending on patient preference (Figure 2) illustrates the relative numbers of visits by VA video conference (telephone and face-to-face) (F2F) from March 24 through June 27, 2020. Clinical services offered by telehealth include consultation, follow-up visits covering new or interim history, physical exam  (considerably limited with the telephone visits, moderately so with video), working diagnosis, ordering imaging/labs, prosthetics, referral to other departments and treatment including dietary assessment/counseling, stress management, and activity prescriptions. Figure 3 depicts a video telehealth visit. 

Figure 2 Visits by VVC, telephone F2F over time

Discussion

Chiropractic telehealth services at VAGLAHS allowed for the continuation of clinical care and created a bridge for veterans to practice self-care while waiting for the resumption of in-person care. It also allowed the department to avoid cessation of the chiropractic resident’s clinical duties. Telehealth allows continued clinical care for veterans who still wish to avoid visiting the clinic. It has also permitted the creation of hybrid visits where the initial component of the visit (taking a new or interim history), can be conducted by phone or video, reducing F2F time in the clinic to lessen the potential spread of infection.