Dr. Malissa Kraft, a Neuropsychologist at the VA Bedford Healthcare System https://www.bedford.va.gov in Mass., felt the need to create a teleneuropsychology clinic to serve older veterans with cognitive aging concerns which mainly are related to Alzheimer’s disease.
With limited access to specialized experts in cognitive aging, people with dementia are underdiagnosed in about 40% of primary care settings. The teleneuropsychology clinic is limited to patients 55 and older. Although most of the evaluations are related to assessing the presence of dementia, the clinic is not specific to treating dementia.
A study conducted at the clinic included 131 veterans who were enrolled pre-COVID and divided evenly between tele-users of the VA Bedford’s Teleneuropsychology clinic and also veterans who come in person to the facility.
However, in the study, it was found that the two groups did not differ in age, level of education, or gender makeup, but it was found that in general, the telehealth group was at a much greater socioeconomic disadvantage.
The study enabled neuropsychology clinicians at VA Bedford to be connected via a video hookup to patients who were chosen from five community-based outpatient clinics affiliated with the Manchester VA Medical Center in New Hampshire. A series of cognitive tests given to the veterans in the teleneuropsychology program were also given to the veterans who attended the study in person.
It was unsurprising to the researchers that the findings showed that patient satisfaction was high for all aspects of the patient experience. Malissa Kraft and her team wrote, “Future research should continue to validate evaluation measures used in telehealth settings, identify the populations that would benefit most from teleneuropsychology services, and explore expanding those services.
Malissa Kraft also reports that a patient can generally get the same quality exam in a teleneuropsychology clinic but it can differ when the patient receives the exam is at home. At home, factors such as weak or non-existent internet connections, background noise and distractions, and the inability to watch the patient perform paper-based tasks involving writing or drawing, can negatively impact the quality of the evaluation at the home.
In Kraft’s view, the fact that the clinician is not physically on site with the patient does not present many limitations as a telehealth clinical technician is always on site with the patient in the home. The technicians are specifically trained to assist with telehealth visits.
Summing up, the VA Bedford Healthcare System is one of only a few VA medical centers that use the teleneuropsychology clinic-to-clinic model. A small number of VA sites use the clinic-to-home model, but Kraft believes clinic-to-clinic is better to use when there isn’t a telehealth clinical technician with the patient at home.