Contact CADC Program

CADC Stories

UCSF-San Francisco CADC Telemedicine

Background

The goal of telemental health is to provide specialized quality mental health services to veterans in the geographically remote areas where access to specialized care may be limited. Telemedicine is increasingly being used to provide consultation for health care in rural areas. Little work has been done with dementia although preliminary research suggests that clinical diagnosis performed via telemedicine consultation is valid. We used telemedicine to evaluate patients with cognitive impairment in rural Northern California using a multidisciplinary team to determine if a clinical diagnosis and treatment recommendations could be made using this technology.

Methods

Patients at a rural veteran’s community clinic nearly 300 miles north of San Francisco were referred by their local provider for evaluation of memory complaints by the multidisciplinary team of the San Francisco Veterans Administration (SFVA) Memory Disorders Clinic (MDC). The telemedicine team consisted of a physician who performed a history and focused physical exam and a neuropsychologist who administered selected components of a neuropsychological battery used in the MDC and a liaison clinician at the community clinic was trained by MDC staff in the evaluation of patients with cognitive impairment and was present for the evaluation to facilitate the components of the evaluation Community clinic staff attended the MDC case conference via telemedicine to discuss diagnosis and recommendations.

Results

We have evaluated 10 new patients. Patients included those unable to travel to the SFVAMC who had an involved caregiver. Patients with significant sensory deficits (eg hearing or vision) or moderate-severe dementia (Mini Mental State Examination < 15) were excluded. In each case, the telemedicine format permitted the MDC team to arrive at a working diagnosis; 7 patients with dementia, 2 with mild cognitive impairment and 1 cognitively normal. Relevant treatment recommendations (antidepressant therapy, cholinesterase inhibitors, counseling about vascular risk factor reduction and behavioral management strategies) were made to the patients and discussed with providers who joined the clinic conference.

Conclusions

Telemedicine is emerging as an effective way to provide consultation and care to rural residents who may not have access to specialty services. Further research about outcomes is needed.

What Services Does The UCSF-San Francisco CADC clinic Located at the San Francisco VAMC Provide Via Telemental Health?

  • Specialty consultation to Eureka's Community-Based Outpatient Clinic (CBOC) providers and patients for evaluation of cognitive complaints, including comprehensive history and neurological exam and neuropsycological testing. The telemedicine consultation service is limited to Eureka CBOC at this time due to CBOC staff training and availability.
  • Ongoing consultation and management of patients with cognitive complaints including pharmacologic and nonpharmacological management.
  • Patient Education and Discussion Group – Interactive didactic/discussion group presented every 4 – 6 weeks via telemedicine to Eureka, Ukiah and Santa Rosa CBOC’s. Topics include Normal Aging, Diagnosis and Management of Dementia; Medications and Dementia, Legal Issues and Dementia, Caregiving and Dementia, End of Life Issues and Dementia
  • Provider Education – Quarterly interactive offerings for providers at Eureka, Ukiah and Santa Rosa CBOC’s via telemedicine. Topics include: Neurological Exam for the Non-neurologist, Medications and Cognitive Complaints, Management of Behavioral Symptoms in Dementia