Perceived benefits of geriatric specialty telemedicine among rural patients and caregivers

Objective

Explore the perceived benefits of a Veterans Health Administration (VHA) geriatric specialty telemedicine service (GRECC Connect) among rural, older patients and caregivers to contribute to an assessment of its quality and value.

Data Sources

In Spring 2021, we interviewed a geographically diverse sample of rural, older patients and their caregivers who participated in GRECC Connect telemedicine visits.

Study Design

A cross-sectional qualitative study focused on patient and caregiver experiences with telemedicine, including perceived benefits and challenges.

Data Collection

We conducted 30 semi-structured qualitative interviews with rural, older (≥65) patients enrolled in the VHA and their caregivers via videoconference or phone. Interviews were recorded, transcribed, and analyzed using a rapid qualitative analysis approach.

Principal Findings

Participants described geriatric specialty telemedicine visits focused on cognitive assessments, tailored physical therapy, medication management, education on disease progression, support for managing multiple comorbidities, and suggestions to improve physical functioning. Participants reported that, in addition to prescribing medications and ordering tests, clinicians expedited referrals, coordinated care, and listened to and validated both patient and caregiver concerns. Perceived benefits included improved patient health; increased patient and caregiver understanding and confidence around symptom management; and greater feelings of empowerment, hopefulness, and support. Challenges included difficulty accessing some recommended programs and services, uncertainty related to instructions or follow-up, and not receiving as much information or treatment as desired. The content of visits was well aligned with the domains of the Age-Friendly Health Systems and Geriatric 5Ms frameworks (Medication, Mentation, Mobility, what Matters most, and Multi-complexity).

Conclusions

Alignment of patient and caregiver experiences with widely-used models of comprehensive geriatric care indicates that high-quality geriatric care can be provided through virtual modalities. Additional work is needed to develop strategies to address challenges and optimize and expand access to geriatric specialty telemedicine.     

Two-year clinical evaluation of a pit and fissure sealant. Part II. Caries initiation and progression.

For the study, 479 paired permanent teeth and 20 paired deciduous teeth were coated under controlled clinical conditions with Nuva-Seal. A red dye was added to assist in placement and subsequent evaluation over a two-year period. Eighty-four children (ages 10 to 14) participated in the study. Caries was evaluated 3, 6, 12, and 24 months later with the same rating scale used at the baseline examination (0, caries free, to 4, severe caries), except when the sealant was found completely present and intact; then caries evaluation was limited to visual inspection through the sealant. The caries rate for control teeth was 6.9% at 3 months, 16.1% at 6 months, 26.4% at 12 months, and 37.6% at 24 months. Corresponding percent effectiveness figures for the sealant were 63.6%, 66.6%, 61.7%, and 54.6%, respectively. At 24 months, effectiveness rates for all types of teeth were at least 52% with the exception of the maxillary second molars (only 27% sealant effectiveness). Overall, caries protection as reflected by percent effectiveness was higher for mandibular teeth and premolars than for maxillary teeth and molars. There was significant effect on the incidence of dental caries when the sealant remained completely intact. Percentage effectiveness rates in this case were 90.7% at 12 months and 90.9% at 24 months. There was little gain or loss in caries protection when the sealant was partially or completely missing. Twenty-four percent of the children had a positive net gain or treatment effect at three months. This increased to 52% at 6 months, 62% at 12 months, and 70% at 24 months. With the use of half-mouth caries rates, the corresponding figures for positive treatment effects were slightly higher (30%, 64%, 70%, and 80% respectively).