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Dementia care in rural areas: A cross‐sectional study from the Wisconsin Alzheimer’s Institute (WAI) Dementia Diagnostic Clinic Network
Author(s) -
Pinzon Maria C Mora,
Krainer Jody,
Houston Stephanie,
GreenHarris Gina,
Norris Nia,
Walaszek Art,
Johnson Sterling C,
Carlsson Cynthia M
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.044592
Subject(s) - dementia , rurality , metropolitan area , medicine , rural area , gerontology , quality of life (healthcare) , cross sectional study , family medicine , health care , disease , nursing , pathology , economics , economic growth
Background The Wisconsin Alzheimer’s Institute (WAI) Dementia Diagnostic Clinic Network includes 38 affiliated clinics across 24 healthcare systems in Wisconsin. Its purpose is to promote the use of evidence‐based strategies to provide high quality care for people with dementia across the state. The clinics follow a set of guidelines that are tailored to address the challenges of providing specialized care in rural areas (e.g. travel burden, transportation, limited resources, lack of trained healthcare providers, social isolation, among others). The purpose of this study is to describe the characteristics of patients seen in rural areas of Wisconsin, the care provided and how it compares to the models of care seen in urban areas. Methods Cross‐sectional study including the patients seen at the WAI’s Clinic Network between September 2018 and January 2020. Demographics, clinical diagnosis, and quality of care provided were compared according to rurality (metropolitan, micropolitan, rural) using the Urban‐Rural Classification Scheme for Counties (URCSC) which was assigned using the location of the submitting clinic. Results Over the study period, 1,769 patients were identified: 61% female, 69% between 65 and 84 years old, and 78% diagnosed with dementia or mild cognitive impairment. Overall, 15% of the patients were seen in rural areas, 8% in micropolitan areas, and 76% in metropolitan areas. Patients in rural areas were older, drove longer distances to the clinic, had lower educational attainment level, and were more likely to be self‐referred than those in metropolitan areas. Clinics in rural areas were more likely to provide educational materials, referrals to local resources in the first visit, and to refer patients for further neuropsychology or specialty evaluation before an etiology was identified. As a result, these clinics were less likely to provide a complete diagnosis in the first visit, but provide more caregiver support and management of behavioral symptoms. Conclusions WAI’s affiliated clinics in rural areas of Wisconsin use referral patterns that differ from their counterparts in metropolitan areas, including making more connections to local resources. More research is needed to identify additional resources and clinic models to improve dementia care in rural areas.