Iyer Sowmya S, Ngo Victoria, Humber Marika Blair, Chen Peijun, Pallaki Muralidhar, Dolinar Teresa, Brodrick Marisa-Francesca B, Gould Christine E, Trivedi Ranak B
Geriatric Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.
Division of Primary Care and Population Health, Geriatrics Section, Stanford University School of Medicine, Palo Alto, CA, USA.
J Gen Intern Med. 2023 Oct;38(13):2960-2969. doi: 10.1007/s11606-023-08188-2. Epub 2023 May 2.
BACKGROUND: For the 5 million persons living with dementia (PLWD) in the USA, telemedicine may improve access to specialty care from their homes. OBJECTIVE: To elicit informal caregiver perceptions of tele-dementia care provided during COVID-19. DESIGN: Qualitative, observational study using grounded theory. PARTICIPANTS: Informal caregivers aged 18 + who cared for an older adult who received tele-dementia services at two major VA healthcare systems participated in 30-60-min semi-structured telephone interviews. INTERVENTIONS: Interviews were designed using Fortney's Access to Care model. MAIN MEASURES: Thirty caregivers (mean age = 67, SD = 12, 87% women) were interviewed. KEY RESULTS: Five major themes were (1) Tele-dementia care avoids routine disruption and pre-visit stress; (2) Transportation barriers to in-person visits include not only travel logistics but navigating the sequelae of dementia and comorbid medical conditions. These include cognitive, behavioral, physical, and emotional challenges such as balance issues, incontinence, and agitation in traffic; (3) Tele-dementia care saves time and money and improves access to specialists; (4) Tele-dementia facilitated communication between caregiver and provider without hindering communication between PLWD and provider; and (5) Caregivers described ideal future dementia care as a combination of virtual and in-person modalities with in-home help, financial and medical support, and dementia-sensitive caregiver access. Caregivers interviewed saved 2.6 h ± 1.5 h (range: 0.5 to 6 h) of travel time. Multiple caregivers described disruption of routines as difficult in PLWD and appreciated the limited preparation and immediate return to routine post telemedicine visit as positives. CONCLUSIONS: Caregivers found tele-dementia care convenient, comfortable, stress reducing, timesaving, and highly satisfactory. Caregivers would prefer a combination of in-person and telemedicine visits, with an opportunity to communicate with providers privately. This intervention prioritizes care for older Veterans with dementia who have high care needs and are at higher risk for hospitalization than their same age counterparts without dementia.
背景：对于美国500万痴呆症患者（PLWD）而言，远程医疗或许能改善他们在家中获得专科护理的机会。 目的：了解非正式照护者对新冠疫情期间提供的远程痴呆症护理的看法。 设计：采用扎根理论的定性观察性研究。 参与者：年龄在18岁及以上、照顾在两个主要退伍军人事务部医疗系统接受远程痴呆症服务的老年人的非正式照护者参加了30 - 60分钟的半结构化电话访谈。 干预措施：访谈采用福尔特尼的就医模式进行设计。 主要测量指标：对30名照护者（平均年龄 = 67岁，标准差 = 12，87%为女性）进行了访谈。 关键结果：五个主要主题为：（1）远程痴呆症护理避免了日常干扰和就诊前的压力；（2）面对面就诊的交通障碍不仅包括出行安排，还包括应对痴呆症后遗症和合并症。这些包括认知、行为、身体和情感方面的挑战，如平衡问题、大小便失禁以及在交通中的躁动不安；（3）远程痴呆症护理节省时间和金钱，并改善了获得专科医生服务的机会；（4）远程痴呆症护理促进了照护者与提供者之间的沟通，同时不妨碍痴呆症患者与提供者之间的沟通；（5）照护者将理想的未来痴呆症护理描述为虚拟和面对面模式的结合，并伴有居家帮助、经济和医疗支持以及对痴呆症敏感的照护者服务。接受访谈的照护者节省了2.6小时±1.5小时（范围：0.5至6小时）的出行时间。多名照护者表示，日常活动的中断对痴呆症患者来说很困难，并对远程医疗就诊准备有限且就诊后能立即恢复日常活动这一点表示赞赏。 结论：照护者发现远程痴呆症护理方便、舒适、能减轻压力、节省时间且非常令人满意。照护者更倾向于面对面就诊和远程医疗就诊相结合，并希望有机会与提供者私下交流。这项干预措施优先照顾有高护理需求且比同龄无痴呆症者住院风险更高的老年痴呆症退伍军人。
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