Teleneuropsychology clinic development and patient satisfaction

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 ¼ 67) and in-person (n ¼ 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.

Survey Findings About the Experiences, Challenges, and Practical Advice/Solutions Regarding Teleneuropsychological Assessment in Adults

“…However there is also evidence that older adults prefer to use online technology for some aspects of their everyday functioning, such as money management ( Sunderaraman et al, 2020 ). Emerging research on the acceptability of TeleNP in various contexts during the COVID-19 pandemic suggests that many examinees find TeleNP services satisfactory ( Appleman et al, 2021 ; Gardner et al, 2021 ; Parsons et al, 2021 ). Prior telepsychiatry research also suggests that patients, especially those with limited access to in-person healthcare services in their communities, are highly satisfied with telehealth services, and in some cases prefer telehealth appointments over in-person visits ( Chong & Moreno, 2012 ; Hilty et al, 2007 ; Shore, 2013 ).…”

Telehealth Support for Dementia Caregivers During the COVID-19 Pandemic: Lessons Learned From the NYU Family Support Program

“…Though there was some apprehension about the usability of video telehealth with older adults due to concerns about technological literacy, research has shown that older adults are interested in learning about new technology and are willing and able to adopt new technology, 21 , 22 with no difference in satisfaction ratings between telehealth and in-person settings. 23 , 24 Multiple recent studies suggest high satisfaction with care and no detriment to the patient-provider relationship among older adults using telehealth.…”

Implementation of a Hybrid Teleneuropsychology Method to Assess Middle Aged and Older Adults During the COVID-19 Pandemic

“…(2014) survey results indicated in their group of healthy older adult participants 17% preferred teleNP and 39% had no preference to testing condition. An in-clinic teleNP method for assessment of regional veterans found participant satisfaction of a full teleNP neuropsychological assessment was high for those assessed in a remote clinic ( Appleman et al., 2021 ).…”

“…In-clinic teleNP utilizes videoconferencing to assess an individual situated in a remote clinic, usually with an assistant on site to aid the assessment ( Appleman et al., 2021 ; Postal et al., 2021 ). This method has typically been used for those living in rural or regional communities or those whom have to travel long distances to attend an assessment.…”

“…This method has typically been used for those living in rural or regional communities or those whom have to travel long distances to attend an assessment. Although evidence suggests in-clinic teleNP is an appropriate method for assessment for older adults and those with cognitive impairment ( Appleman et al., 2021 ; Cullum, Hynan, Grosch, Parikh, & Weiner, 2014 ; Cullum, Weiner, Gehrmann, & Hynan, 2006 ; Hildebrand, Chow, Williams, Nelson, & Wass, 2004 ; Marra, Hamlet, Bauer, & Bowers, 2020 ; Postal et al., 2021 ), the requirement of an assistant means this method is not necessarily suitable during a pandemic.…”