Gaining access to specialty care services, including neuropsychology, can be challenging, especially for older adults and individuals who live in rural areas. In addition to these barriers, the ongoing COVID-19 pandemic further disrupted patient access to essential healthcare services. Telehealth, which underwent rapid expansion in response to service disruptions due to COVID-19, offers opportunities to prevent or reduce disruptions in patient care, including neuropsychological assessment. Here we describe the development and implementation of a teleneuropsychology (telenp) clinic within a major VA medical center and discuss salient clinical observations and patient feedback gathered during telenp evaluations.

A hybrid telenp clinic was developed at the Tennessee Valley VA Healthcare system to serve patients referred for neuropsychological evaluations whose access to services was impacted by the COVID-19 pandemic. Patients presented to the VA and were connected to neuropsychology providers seated in separate rooms of the hospital through synchronous video. Test batteries were created to closely approximate in-person evaluations while allowing for minor procedural modifications so tests could be administered virtually. All tests were administered by on-site trained staff. After the evaluation, anecdotal information about patient experiences and satisfaction and salient clinical observations were gathered to elucidate potential benefits and shortcomings of hybrid telenp model.

65 telenp neuropsychological evaluations were conducted between December 2020 and April 2021. Overall, patients consistently and strikingly reported a high degree of openness and acceptance towards telenp services, even despite initial technological apprehension. Importantly, patients ubiquitously reported believed they were able to adequately engage in telenp assessments, and no perceptible barriers were identified. Clinically, examiners consistently expressed surprise at the relative ease with which the evaluations could be adapted to a telenp program. Additionally, clinicians generally felt confident in the validity of the results and that the data gathered were sufficient to answer the referral question and make salient treatment recommendations and referrals. Importantly, there were some notable limitations to telenp assessment and not all patients were testable via telehealth.

Qualitatively, hybrid telenp evaluations are feasible and acceptable, and appear to be a valid alternative to face to face neuropsychological assessments. Future research should focus on establishing the reliability and validity of telenp testing compared to face-to-face testing, collective quantitative data regarding patient and clinician experiences of telenp and identify methods for implementing telenp in clinics in rural catchment areas to increase access to neuropsychological services.