Implementation of an interprofessional approach to assessment and care planning in ambulatory older adults with cognitive impairment

Background Medicare‐reimbursed assessment and care planning for cognitive impairment and associated functional decline requires a comprehensive approach that may be challenging for medical practices to implement. An interprofessional team approach to this service utilizes unique strengths of team members to optimize care. Methods The University of Colorado Health Seniors Clinic developed an interprofessional “Memory Clinic,” in May 2017 to meet these needs. The team includes geriatricians, clinical pharmacists, a social worker, and medical assistants who are part of the larger Seniors Clinic team. Patients referred to the “clinic” are scheduled for a 40‐minute appointment with a geriatrician for medical, cognitive and functional assessment; receive a pharmacist‐provided cognition‐focused medication, lab, and recreational drug review; and visit with the social worker for functional and caregiver support and resources. Medical assistants assess vital signs and perform depression screening prior to the physician appointment. Medicare Part B is billed for the visit using CPT code 99483. Results A review of the electronic medical record identified 112 patients referred to the “clinic” through early December 2019. The mean patient age was 82 years (range 71‐96 years) and all patients received a pharmacist review. 94 (84%) were seen by a geriatrician, and 51 (46%) met separately with a social worker. The majority of patients evaluated by the geriatrician were assessed with the MOCA test (86%, mean score 17.9/30) and the FAST (95%, most common stages 2 and 4). Almost two‐thirds of patients had documented advance directives and a majority had caregivers present at the visit (72%). The pharmacist review identified a mean 2.4 medications per patient that could contribute to cognitive impairment and additional laboratory assessment needed in approximately 50% of patients. FDA‐approved pharmacologic treatments for dementia were prescribed in 17 (15%) patients. A small number of patients stated they regularly ingested marijuana (n=3), applied it topically (n=2), or drank alcohol excessively (n=11). Conclusions An interprofessional team‐based approach to cognitive impairment screening and care planning was successfully implemented in a University‐based ambulatory geriatrics clinic. Evaluated patients were found to most often be mildly impaired and have several medications that could be impacting their cognition.