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A consortium that links Texas health care providers to a distinguished research facility is turning its attention to telemedicine as a means of improving access for Alzheimer’s patients and making more efficient use of their physicians’ time. The James L. West Alzheimer's Center, a Fort Worth, TX, nonprofit facility that provides care to people with Alzheimer’s disease and related disorders, has joined the Consortium on Alzheimer’s Research and Education program at the University of North Texas (UNT) Health Science Center, also in Fort Worth.
The UNT Health Science Center comprises the Texas College of Osteopathic Medicine, the School of Public Health, and the Graduate School of Biomedical Sciences. Its six Institutes for Discovery conduct research on select health issues, including vision, aging, cancer, heart disease, physical medicine, and public health.
Their first research project involves a pilot program studying the feasibility of using telemedicine to evaluate and treat people with Alzheimer’s disease. An interactive computer system has been installed between the two facilities to allow residents, staff, and physicians to talk and see one another in real time. "There is not much of a history of telemedicine in the long-term environment," notes Thomas Fairchild, PhD, director of special projects on aging at UNT. "Since we are breaking new ground, we are trying to go slow."
The consortium has had a tough time getting off the ground, Fairchild notes, because of the challenges facing nursing homes. "A couple of other facilities in the state have participated since we began about two years ago, but it’s been a slow process, in part because of the struggles nursing homes are having with reimbursement and litigation. With 25% to 30% of the homes in or near bankruptcy, they’re focusing more on survival than research," he explains.
In light of these challenges, UNT has been seeking to link its researchers and faculty with providers that can help them impact the evaluation, treatment, and prevention of Alzheimer’s. "We’re not trying to grab every facility out there, but those we think are consistent with our culture and will facilitate long-term progress," he notes.
These were some of the considerations that led UNT to James L. West, along with the proximity of the two facilities to each other. "But probably the single biggest factor that made us most comfortable was that our head of geriatrics has been their co-medical director, so we had confidence and trust built up with both patients and family members," he notes.
Essentially, the system is a PC-based network, Fairchild explains. "At our end, we are using a large-screen TV tied into a PC," he says. "Their end is similar, but they also have a large device with peripherals like osteoscopes and dermascopes, to conduct some of the assessments."
At James L. West, the equipment is set up in the same pod in which the residents live, in a room a little larger than a typical resident’s room. It was important, Fairchild notes, that the location be one that was familiar to the patients. After the equipment and the "T-1" line were installed, the nursing staff were trained in the use of the system. "We also needed to develop instruments to assess the technology," he adds. "Obviously, you can’t ask the patients, so we needed tools that could be used by third-party individuals, to determine if the technology is something the patients are comfortable with," he says.
The patients in the pilot program are in the midstages of Alzheimer’s; they can’t live independently, but they are not bed-bound. "Right now, we are only seeing two to four residents a week," says Fairchild. "If things go well, our plan is to gradually increase the number of patients over the next 60 to 90 days to perhaps eight or 12 a week. On a quick-consult basis, that number may be much higher."
One of the major perceived advantages of this system is that the physician does not have to be in the same facility as the patient to conduct an assessment. "A big issue in our state is aggressive patient behavior," he notes. "If we can do an assessment that’s not face to face, that concern is eliminated. The nurse brings the patient into the room at their facility, and through our video and voice connection, [that patient] is assessed at our facility. This certainly can be a more effective use of the doctor’s time, as well, and will hopefully increase access to care for the patients," Fairchild says.
The initial concern is how the patients relate to the technology, and so far, it has not been a problem, he reports. "What we would love to do, if we can make it work in this environment, is try expand it to some other sites that are participating in our consortium," Fairchild concludes.
For more information, contact:
• Thomas Fairchild, PhD, Director of Special Projects on Aging, UNTHSC, 3500 Camp Bowie Blvd., Fort Worth, TX 76107. Telephone: (817) 735-5497. Fax: (817) 735-0483. E-mail: firstname.lastname@example.org.