Cargando…

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

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) base...

Descripción completa

Detalles Bibliográficos
Autores principales: Chang, Woody, Homer, Marcia, Rossi, Michelle I.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319231/
https://www.ncbi.nlm.nih.gov/pubmed/31011082
http://dx.doi.org/10.3390/geriatrics3030044
_version_ 1783385037797851136
author Chang, Woody
Homer, Marcia
Rossi, Michelle I.
author_facet Chang, Woody
Homer, Marcia
Rossi, Michelle I.
author_sort Chang, Woody
collection PubMed
description 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.
format Online
Article
Text
id pubmed-6319231
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-63192312019-03-07 Use of Clinical Video Telehealth as a Tool for Optimizing Medications for Rural Older Veterans with Dementia Chang, Woody Homer, Marcia Rossi, Michelle I. Geriatrics (Basel) Article 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. MDPI 2018-07-30 /pmc/articles/PMC6319231/ /pubmed/31011082 http://dx.doi.org/10.3390/geriatrics3030044 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Chang, Woody
Homer, Marcia
Rossi, Michelle I.
Use of Clinical Video Telehealth as a Tool for Optimizing Medications for Rural Older Veterans with Dementia
title Use of Clinical Video Telehealth as a Tool for Optimizing Medications for Rural Older Veterans with Dementia
title_full Use of Clinical Video Telehealth as a Tool for Optimizing Medications for Rural Older Veterans with Dementia
title_fullStr Use of Clinical Video Telehealth as a Tool for Optimizing Medications for Rural Older Veterans with Dementia
title_full_unstemmed Use of Clinical Video Telehealth as a Tool for Optimizing Medications for Rural Older Veterans with Dementia
title_short Use of Clinical Video Telehealth as a Tool for Optimizing Medications for Rural Older Veterans with Dementia
title_sort use of clinical video telehealth as a tool for optimizing medications for rural older veterans with dementia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319231/
https://www.ncbi.nlm.nih.gov/pubmed/31011082
http://dx.doi.org/10.3390/geriatrics3030044
work_keys_str_mv AT changwoody useofclinicalvideotelehealthasatoolforoptimizingmedicationsforruralolderveteranswithdementia
AT homermarcia useofclinicalvideotelehealthasatoolforoptimizingmedicationsforruralolderveteranswithdementia
AT rossimichellei useofclinicalvideotelehealthasatoolforoptimizingmedicationsforruralolderveteranswithdementia