Abstract
Context: A clinical video telehealth (CVT) program was implemented to improve access and quality of dementia care to patients and their caregivers in rural areas. The program was offered as part of an established dementia clinic/geriatric primary care clinic in collaboration with five community-based outpatient clinics (CBOC’s) affiliated with the Tennessee Valley Healthcare System (TVHS) in middle Tennessee. Telehealth support was provided by a physician–social worker team visit. Methods: Telehealth training and equipment were provided to clinic personnel, functioning part-time with other collateral clinical duties. Patients and caregivers were referred by primary care providers and had an average of one to two CVT encounters originating at their local CBOC lasting 20 to 30 min. Clinical characteristics and outcomes of patients and caregivers receiving CVT support were collected by retrospective electronic medical record (EMR) review. Results: Over a 3-year period 45 CVT encounters were performed on patient–caregiver dyads, followed for a mean of 15 (1–36) months. Some 80% patients had dementia confirmed and 89% of these had serious medical comorbidities, took an average of eight medications, and resided at a distance of 103 (76–148) miles from the medical center. Dementia patients included 33% with late stage dementia, 25% received additional care from a mental health provider, 23% took antipsychotic medications, 19% transitioned to a higher level of care, and 19% expired an average of 10.2 months following consultation. Significant caregiver distress was present in 47% of family members. Consult recommendations included 64% community-based long-term care services and supports (LTSS), 36% medications, and 22% further diagnostic testing. Acceptance of the CVT encounter was 98%, with 8770 travel miles saved. Conclusions: CVT is well received and may be helpful in providing dementia care and supporting dementia caregivers to obtain LTSS for high-need older adults in rural areas.
Highlights
Dementia patients included 33% with late stage dementia, 25% received additional care from a mental health provider, 23% took antipsychotic medications, 19% transitioned to a higher level of care, and 19% expired an average of 10.2 months following consultation
Progressive disability and higher mortality associated with dementia care require supportive and proactive healthcare models to address these issues
We report our innovative application of real-time video technology coupled with care management and principles of team care, utilizing the electronic health record (EHR) to deliver dementia care to rural veterans in the Tennessee Valley Healthcare System (TVHS) service area
Summary
Alzheimer’s disease affects 47 million individuals worldwide, including 5 million individuals and 15 million caregivers in the United States [1]. Dementia patients are increased utilizers of health services, with a 57% increase in healthcare costs in the last five years of life [2]. Progressive disability and higher mortality associated with dementia care require supportive and proactive healthcare models to address these issues. Proactive medical and psychosocial care management improves quality of life and other health outcomes and increases quality of care by adherence to guidelines and referrals to community long-term care services and supports (LTSS) [3]. Caregiver distress is common among dementia caregivers, [4] and there is a great need to engage and support dementia family caregivers [5]
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