MISSION:  Establish a “Virtual Memory Disorders Consultative Clinic” to provide primary care internists, psychiatrists, and neurologists with access to tertiary dementia sub-specialist expertise, without actually referring the patients themselves. 

In the Commonwealth of Virginia, demand for tertiary level dementia resources currently exceeds its availability.  It is hoped this service will provide an alternative mechanism through which primary physicians can obtain desired tertiary-level assistance for questions that arise during the course of diagnosing or managing persons with cognitive disorders. 

Primary physicians face many challenges when caring for persons with dementia, challenges that may vary among the different regions of the Commonwealth.  The impact of an AD diagnosis on an individual and his or her family is influenced by education and financial factors, as well as by the availability of various ancillary services such as adult day care.  Therefore, a secondary intent of this virtual clinic will be to identify on a regional basis the most immediate needs of persons with dementia, their families, and their medical providers.

Work Plan

The work plan will result in a virtual clinic modeled on existing clinical settings stimulated by federal initiatives.

Background

In the 1980’s, the National Institute of Aging (NIA) of the National Institutes of Health (NIH) established regional centers designed to enhance our understanding of Alzheimer’s disease (AD), the most common form of late-onset dementia.  This led to the development of clinics dedicated to the care of persons with memory disorders.  To staff these clinics, it was necessary to concentrate dementia sub-specialists at tertiary referral centers. For primary care providers, memory disorders clinics represent a diagnostic resource for cases in which a diagnosis is unclear, and can provide state-of-the-art assistance with patient management issues.

The University of Virginia Memory Disorders Clinic

In 1996, a dedicated Memory Disorders Clinic (MDC) was established at the University of Virginia (UVA) Health System.  The clinic pooled appropriate expertise within the UVA Department of Neurology.  This expertise included (but was not limited to) two cognitive disorders sub-specialist neurologists, a neuropsychologist, a dedicated nurse coordinator, and social worker.  Multiple members of the group were experienced in the conduct of AD drug trials.

A Pilot Program to Establish a “Virtual Memory Disorders Consultative Clinic”

To our knowledge, this Virtual Memory Disorders Consultative Clinic will be the first of its kind.  We therefore propose to proceed with a simplified pilot version.  For this pilot version, the state will be divided into distinct geographic districts.  A “clinic hour” for each district will be specified.  Advance notice of the clinic hour will be disseminated to district physicians.  During the hour, district physicians with questions about dementia diagnosis/management issues will be able to join a telephone conference call lead by a tertiary care dementia sub-specialist.  In this manner, primary physicians can seek input from the specialist on individual patients felt not to require formal referral, but who might nevertheless still benefit from expert advice.

In the pilot version, this virtual clinic will be staffed by the three memory disorder sub-specialists of the UVA MDC (Drs. Swerdlow, Geldmacher, and Brashear).  Staffing centralization will help the organizers identify practical limitations inherent to the model, as well as facilitate format adjustments.

Initial Steps for Establishing A Virtual Memory Disorders Consultative Clinic

To establish the Virtual Memory Disorders Clinic envisioned above, it is necessary to address and/or resolve the following initial issues: identification of potential legal liability to clinic staffers; patient confidentiality issues; defining of districts (including number, geographic size, and population size); mechanisms for disseminating knowledge of the service; logistics of arranging teleconference calls; procurement of funds to cover the costs of teleconferencing; defining rules for inquiries (for example, limiting individual inquiries to a particular amount of time); determining rules for responses (for example, limiting the amount of time spent on a particular response); and scheduling of clinic sessions

Members

• Russell Swerdlow, M.D. (University of Virginia) -  Chair

• Marilyn Pace Maxwell (Mountain Empire Older Citizens) - Vice-Chair

• Elaine Byrd, Ph.D. (Alzheimer’s Association Central & Western Chapter)

• Cathy Saunders (Alzheimer’s Association Greater Richmond Chapter)

• David Geldmacher, M.D. (University of Virginia)

• Carol King

• Pete Giesen

• Constance Coogle, Ph.D. (Virginia Center on Aging)

• David Sadowski (Crater District Area Agency on Aging)

• Robert Brashear, M.D.

Progress Report

The future goal of the Services core will be to address the issues identified as initial steps for establishing a virtual memory disorders clinic.

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