CLINICAL VIDEO TELEHEALTH (CVT) FOR DEMENTIA: RURAL PROVIDER AND VETERAN RECOMMENDATIONS

Introduction : In rural areas, older patients with cognitive decline, have little access to geriatric providers to provide diagnosis, treatment and support as the disease progresses. The TeleDementia clinic, an interdisciplinary Clinical Video Telehealth (CVT) clinic addresses this need. Methods : Types of recommendations made via CVT by the team of a geriatrician, geriatric psychiatrist, psychologist, and social worker were analyzed and compared to recommendations made to similar patients seen in-person. Results : From 5/2013–9/2015, 341 patients with cognitive decline attended 724 TeleDementia clinic encounters and referring rural providers received 1098 recommendations regarding specialized dementia care. Common themes of recommendations included: referral to VA services n=650(59.2%), evaluation of sensory deficits n=69 (6.3%), treatment/ monitoring of orthostatic hypotension n=61 (5.6%), improving diabetic management n=73 (6.6%), recommendations related to reversible causes of symptoms n=144 (13.1%), Geri Psychiatry referral n=73(6.6%), gun safety, hunting, and driving n=71(6.6 %). . The majority of Veterans received recommendations related to adjusting medications. Fifty-one (15%) of Veteran also had documented polypharmacy. Themes of recommendations were related to specialists seen. Recommendations were similar to those in a face-to-face dementia clinic. Implementation of recommendations was initially low but improved when the geriatric team initiated consults, services, and follow-ups. Conclusion : Recommendations made in TeleDEMENTIA clinic are common to clinical recommendations made by geriatric professionals when Veterans are seen face to face. What makes these recommendations notable is these Veterans may never have received any recommendations without access to dementia care by telehealth. Implementation of recommendations improved when the team initiated services.