Implementation of a virtual dementia system of care in a VA health setting

Dementia care remains supportive and geriatric resources are scarce. We describe a dementia system of care consisting of virtual and e-consults working through the primary care provider, as well as providing virtual group caregiver support. These models were developed based on patient and caregiver preferences and necessitated by the Covid public health emergency.

A geriatrician supported dementia consult clinic transitioned to a virtual model of care. A centrally located caregiver support group providing a 4-week curriculum and delivered in conjunction with a social worker similarly transitioned to virtual support. Primary care providers generated consults and were provided educational consultations regarding dementia diagnoses and management in the primary care setting.

Between 2018 and 2024, 1176 consultations were provided during this period as the clinic transitioned from in-person to virtual consultation. Recommendation categories included: (1) diagnostic testing, (2) medication recommendations and deprescribing, (3) referral for formal neuropsychological testing, (4) psychiatric referral for behavioral concerns, (5) primary care management and goals of care, (6) safety considerations, (7) home and community-based services, and (8) caregiver support. Providers continue to send new consultations and request follow-up advice on previous consults. A total of 72 family caregivers participated in a virtual 4-class support curriculum.

Virtual and e-consult dementia care working through the primary care provider, as well as virtual group caregiver support, are feasible, acceptable and sustainable models of dementia care to efficiently utilize scarce geriatrics resources serving a wide geographic area. A virtual dementia system of care may facilitate PCP delivery of supportive care for persons living with dementia, dementia care navigation, and caregiver support.