Powers Becky B, Homer Marcia C, Morone Natalia, Edmonds Natali, Rossi Michelle I
Geriatrics Research Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas.
Division of Geriatrics, Gerontology and Palliative Care, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
J Am Geriatr Soc. 2017 May;65(5):1092-1099. doi: 10.1111/jgs.14839. Epub 2017 Mar 10.
The teledementia clinic is a new model of care that expands the reach of specialized geriatric and dementia care using clinical video telehealth (CVT) to rural veterans, who frequently lack access to specialty care. The clinic is a Veterans Affairs (VA) Geriatric Research, Education, and Clinical Center clinical demonstration project. It is located in the Pittsburgh VA Healthcare System tertiary referral hospital and serves veterans in affiliated rural community-based outpatient clinics (CBOCs). Rural CBOC primary care providers refer clinic patients, or referral is according to previous cognitive impairment diagnosis in a VAPHS geriatric clinic. Patients undergo interprofessional dementia assessment by a geriatrician, geropsychologist, geriatric psychiatrist or neurologist, and social worker using CVT technology. Metrics for clinic evaluation included rural patients served and savings in travel time, distance, and costs. Assessments collected depended upon individual presentation and included cognitive tests, geriatric depression scales, functional assessment, and the Zarit Burden Interview. A patient satisfaction survey was created and administered. In the first year, 95 individuals were served in 156 clinic visits and 251 interprofessional provider encounters. Of patients served, 61 lived in rural ZIP codes, 72 were diagnosed with dementia, 19 were diagnosed with mild cognitive impairment, and four were found to have primarily psychiatric diagnoses rather than cognitive impairment. The average Functional Assessment Staging of Alzheimer's Disease Scale score was 4.3 ± 1.3. This clinic model demonstrates that CVT technology is a feasible means of providing interprofessional dementia evaluations and follow-up to rural presidents.
远程痴呆症诊所是一种新型护理模式，它利用临床视频远程医疗（CVT）将专业的老年病和痴呆症护理服务扩展到经常无法获得专科护理的农村退伍军人。该诊所是退伍军人事务部（VA）老年研究、教育和临床中心的临床示范项目。它位于匹兹堡VA医疗保健系统的三级转诊医院，为附属农村社区门诊诊所（CBOC）的退伍军人提供服务。农村CBOC的初级保健提供者转诊诊所患者，或者根据VAPHS老年病诊所先前的认知障碍诊断进行转诊。患者通过老年病医生、老年心理学家、老年精神病医生或神经科医生以及社会工作者使用CVT技术接受跨专业痴呆症评估。诊所评估指标包括服务的农村患者数量以及旅行时间、距离和成本的节省情况。收集的评估取决于个体表现，包括认知测试、老年抑郁量表、功能评估和扎里特负担访谈。创建并实施了患者满意度调查。在第一年，156次诊所就诊和251次跨专业医疗服务提供者会诊服务了95名患者。在接受服务的患者中，61人居住在农村邮政编码地区，72人被诊断患有痴呆症，19人被诊断患有轻度认知障碍，4人被发现主要患有精神疾病而非认知障碍。阿尔茨海默病功能评估分期量表的平均得分为4.3±1.3。这种诊所模式表明，CVT技术是为农村患者提供跨专业痴呆症评估和随访的可行手段。
