Abstract

Objective: Telehealth offers the opportunity to address a growing need to improve access to specialty services, such as neuropsychology, particularly for older adults and those in rural areas. Initial research has examined the validity and acceptability of teleneuropsychology (teleNP) in research settings, but there is less information about teleNP implementation in clinical practice. Here we describe the development of a teleNP clinic and compare patient satisfaction to those completing in-person neuropsychological evaluations. Method: A teleNP clinic was developed at the VA Bedford Healthcare System to serve older Veterans with referral questions focused on cognitive aging concerns. Patients presented to affiliated VA satellite clinics and were connected to neuropsychology clinicians at the main hospital campus through synchronous video. An evaluation battery was compiled to closely approximate in-person evaluations. Trained staff members at the satellite clinic assisted with administration of select tasks. Patient satisfaction was evaluated using a self-report questionnaire and responses were compared to a group undergoing in-person neuropsychological evaluations. Results: Self-reported satisfaction was high for all aspects of the patient experience, with no significant difference found between teleNP (n = 67) and in-person (n = 64) groups. In particular, 90% of patients in the teleNP group and 98% of patients in the in-person group agreed or strongly agreed with the statement, “I was overall satisfied with this visit.”. Conclusions: TeleNP is a feasible and acceptable alternative to traditional in-person neuropsychological evaluations in clinical practice focused on older adults. Future research should continue to validate evaluation measures used in telehealth settings, identify the populations that would benefit most from teleNP services, and explore the expansion of teleNP services.

摘要

目标：远程医疗提供了机会来满足日益增长的需求，以改善获得专业服务的机会，例如神经心理学，尤其是老年人和农村地区的人。最初的研究已经检验了远程神经心理学 (teleNP) 在研究环境中的有效性和可接受性，但关于远程神经心理学在临床实践中实施的信息较少。在这里，我们描述了 TeleNP 诊所的发展，并将患者满意度与完成面对面神经心理学评估的患者进行了比较。方法：VA 贝德福德医疗保健系统开发了一个 TeleNP 诊所，为老年退伍军人提供关注认知衰老问题的转诊问题。患者就诊到附属的 VA 卫星诊所，并通过同步视频与主要医院校园的神经心理学临床医生联系。编制了一个评估组合，以非常接近面对面的评估。卫星诊所训练有素的工作人员协助管理选定的任务。使用自我报告问卷评估患者满意度，并将回答与接受面对面神经心理学评估的一组进行比较。结果：患者体验的各个方面的自我报告满意度都很高，在远程NP（n = 67）和面对面（n = 64）组之间没有发现显着差异。特别是，teleNP 组中 90% 的患者和面对面组中 98% 的患者同意或强烈同意“我对这次访问总体满意”的说法。结论：在针对老年人的临床实践中，TeleNP 是一种可行且可接受的替代传统面对面神经心理学评估的方法。未来的研究应继续验证远程医疗环境中使用的评估措施，确定最能从远程 NP 服务中受益的人群，并探索远程 NP 服务的扩展。