Abstract
Community-Based Outpatient Clinics (CBOCs) allow delivery of primary care to rural veterans who are far from a main Veterans Affairs (VA) campus. However, CBOCs often do not have physicians with geriatric training. We used a clinical video telehealth (CVT) dementia service (Teledementia clinic) based in the Pittsburgh VA Healthcare System to optimize dementia patients’ medications and potentially inappropriate medications (PIMs). We analyzed 199 CVT patient encounters from 1 January 2016 to 31 December 2016 and compared different medication changes per encounter between the initial CVT consults and the follow-up visits for all medications and PIMs as listed in the 2015 Beers Criteria, to see if there was a decrease of each kind of change, which is being used as a surrogate for optimization. We found that initial CVT consults, compared to follow-up visits, had greater medications added (0.731 vs. 0.434, p = 0.0092), total overall medications changes (1.769 vs. 1.130, p = 0.0078), and the stopping of 2015 Beers Criteria PIMs (0.208 vs. 0.072, p = 0.0255) per encounter. The fewer PIMs discontinued and fewer medication additions in follow-ups implies that our patients’ medications tend to stay optimized between visits. The teledementia service represents a novel way to provide geriatric assistance to CBOC VA primary care physicians for rural veterans with dementia.
Highlights
It is widely known that there is a disparity of care between urban and rural patients
Though not when looking at dosage/timing modifications (0.338 vs. 0.202, p = 0.123). These results show that, for the most part, teledementia services for rural veterans had an effect on Beers List modifications, presumably with the lower numbers in the follow-up visits compared to the initial visit, indicating that the medication list was either optimized with the correct modifications of the Beers List medications and that those modifications, whether changes in dosage/timing or stopping all together, appeared to be carried through to the follow-up visit
The significance found in adds and total medications indicates that a greater number of changes happen in the initial visit and its effects on the medication list is evidence that the medications of the dementia patient were being optimized
Summary
It is widely known that there is a disparity of care between urban and rural patients. Rural patients typically have higher barriers to access general and specialist medical care, leading to poorer outcomes as compared to their urban counterparts [1,2]. This is especially important with the management of dementia. The WHO estimates that there are 50 million patients worldwide with dementia with 10 million new cases annually [3]. Just in the U.S alone, it was estimated to cost $818 billion in 2015, increasing to
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