Use of Clinical Video Telehealth as a Tool for Optimizing Medications for Rural Older Veterans with Dementia

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.

Virtual geriatric clinics and the COVID-19 catalyst: a rapid review

“…The mean age of reported participants was 78.6 years. Three studies were conducted in an exclusive male veterans population [ 14 , 16 , 19 ]. The median study time for the interventions was 12 months (range 5–48 months.…”

“…Seven of the nine studies reported on clinical benefit outcomes ( Table 4 ) [ 12 , 14 , 16–18 , 20 ]. Four studies reported successful medication rationalization [ 14 , 16–18 ].…”

“…Seven of the nine studies reported on clinical benefit outcomes ( Table 4 ) [ 12 , 14 , 16–18 , 20 ]. Four studies reported successful medication rationalization [ 14 , 16–18 ]. Three studies reported that there was a reduction in acute hospitalization events [ 12 , 18 , 20 ].…”

Geriatric Care Models

“…GeriPACTs employ a range of staffing and clinical structures that are adapted to local needs. Clinical video telehealth (CVT) is also being employed by the VA to improve access for rural residents [ 5 ] and for consultative services, including dementia care and caregiver support [ 6 ]. Telehealth appears to be well accepted by patients and effective in optimizing geriatric care and obtaining community-based long-term care services and support (LTSS).…”

Effects of a geriatric outreach program on the care of older adults in Northern British Columbia

“…Outcomes from consultations. Medication changes have been reported as an outcome of geriatric assessment through telehealth (Conn, Madan, Lam, Patterson, & Skirten, 2013), but compared to initial assessment, follow-up assessments through videoconferencing result in fewer medication changes (Chang, Homer, & Rossi, 2018). Chang et al (2018) reported that potentially innapropriate medications were recognized and discontinued more often during initial assessments so that subsequent consultations resulted in fewer medication changes.…”