title: Creation of an Interprofessional Teledementia Clinic for Rural Veterans: Preliminary Data.
abstract: 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.
authors.affiliation: 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.
authors.forename: Becky B
authors.initials: BB
authors.lastname: Powers
authors.affiliation: Geriatrics Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
authors.forename: Marcia C
authors.initials: MC
authors.lastname: Homer
authors.affiliation: Geriatrics Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.|Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Natalia
authors.initials: N
authors.lastname: Morone
authors.affiliation: Geriatrics Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.|Phoenix Veterans Affairs Health Care System, Phoenix, Arizona.
authors.forename: Natali
authors.initials: N
authors.lastname: Edmonds
authors.affiliation: Geriatrics Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.|Division of Geriatric Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Michelle I
authors.initials: MI
authors.lastname: Rossi
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D015577:Geriatric Assessment; D006282:Health Personnel; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D012424:Rural Population / Q000706:statistics & numerical data*; D017216:Telemedicine / Q000295:instrumentation*; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Dementia; Geriatric Health Service; Telemedicine