Dementia Specialists’ Perspectives on Improving Rural Veterans’ Access to Care

TL;DR

This study explores how to improve dementia care access for rural Veterans by understanding specialists' perspectives on current gaps and solutions.

Contribution

The study identifies specific gaps and strategies for improving rural dementia care within the VHA, using a dementia care framework.

Findings

Rural Veterans face gaps in early dementia recognition and limited specialist availability.

Strategies like tele-consults and education for clinicians are suggested to improve care access.

VHA offers better dementia services than rural communities, but coordination and resources remain limited.

Abstract

Outside the Veterans Health Administration (VHA), rurality-based differences in dementia care access have been reported (e.g., fewer physician and home health visits among rural vs. urban residents). However, this has not been examined within the VHA, which prioritizes rural healthcare access. To address this gap, we conducted semi-structured interviews with dementia specialists (N = 20) at five rural VHA medical centers in two regions. Based on Drebig’s “pathways to dementia care” framework, interviews focused on understanding gaps and strategies to meet rural Veterans’ care needs at three stages: dementia warning signs; evaluation and diagnosis; and aligning treatment and services to optimize patient and caregiver quality of life. We analyzed the thematic content of interviews using rapid qualitative analysis. Common gaps reported were 1) need for earlier recognition of dementia warning signs to access services; 2) lack of dementia specialists, particularly in the community; 3) limited resources to support family caregivers; and 4) limited availability of supportive services such as home care, respite, and residential long-term care. Common strategies to address gaps included 1) education and outreach to primary care clinicians; 2) tele-consult services; and 3) care transitions programs for Veterans with challenging behavioral symptoms. Clinicians consistently described VHA as having more robust dementia specialty care services than what was available in the community. Considerable gaps remain in rural access to dementia care around recognition and evaluation of dementia, and coordination and availability of supportive services. Optimizing access to dementia-related services for rural Veterans requires tailored approaches to leverage VHA and community resources.