Alzheimer's Disease and Related Dementia (ADRD) affect 6.7 M older adults in the United States 1. Primary Care Providers (PCPs) are often the first to diagnose and manage ADRD, but frequently report low confidence, discomfort, and limited time for optimal care 1-4. Consequently, nearly one-third of PCPs refer patients to specialized memory clinics (e.g., neurology, geriatrics, neuropsychology) 5, 6. This creates a major barrier to care, especially for older adults in rural areas where access to specialist care is severely limited 7, 8. To bridge this gap and reach people with ADRD in underserved areas, we launched an interdisciplinary Virtual Memory Clinic (VMC) staffed by geriatricians, nurses, and social workers with a specific goal of expanding access to comprehensive dementia care for geographically isolated populations. This builds on our prior work where a virtual memory care model, embedded into primary care provider (PCP) workflows, was pilot tested and provided specialized care virtually to 115 community-dwelling underserved older adults, negating their need to travel to tertiary care centers and improving access to specialty dementia care 9, 10. During this pilot, we observed a notable gap between the number of PWD referred and those likely needing care; with the expansion of our VMC model, we realized the need for marketing outreach was essential because reaching people in remote areas with information on how to access a VMC can be challenging. We describe the efforts that were successful in overcoming the barriers to marketing the VMC to people with ADRD in underserved areas. The VMC launch coincided with the immediate implementation of a simultaneous, two-pronged, multi-faceted outreach strategy: (1) Direct-to-Provider and (2) Direct-to-Consumer (Patient/Family/Caregiver) (Table 1). The design of these strategies was informed by a series of meetings with experts in rural health and outreach/marketing to maximize the VMC's reach to older adults who may not rely on standard medical marketing. While standard recruitment often relies solely on passive PCP referrals, our approach included active consumer-facing digital and community-based efforts. Because the marketing efforts occurred concurrently, we utilized a “How did you hear about us” intake field to track which specific strategy served as impetus for scheduling. Direct-to-Provider (PCP and Health Systems) Direct-to-Consumer (Patient/Family/Caregiver) Radio media Tour (12 Local stations- AM/FM/Sirius radio) Utilized social media “Ask Me Anything” and “digital shorts” on social media to demystify dementia care questions Used EHR data to identify patients benefiting from VMC (Identification via proxy access tags, and Home Health referrals) Targeted direct email campaigns In the first 9 months of the VMC launch and outreach period, our Direct-to-Provider efforts successfully connected with over 100 PCPs. The radio media tour garnered significant attention, with a total of 123 broadcasts in 76 different news markets, and our “Ask Me Anything” program was viewed by 10,581 persons. The EHR data analysis proved highly effective, with a total of 43,573 emails delivered, 17,263 emails opened, and 307 clickthroughs to the clinic home page. Our targeted marketing strategy resulted in a significant increase in referrals, with 190 new patients reporting they learned about the clinic through our outreach efforts. (Figure 1). Reaching people with ADRD in rural and underserved areas to provide memory care is inherently challenging. We successfully developed a multifaceted, data-driven outreach strategy that effectively overcame these challenges in connecting patients to a virtual memory clinic. These early results demonstrate the feasibility of proactively identifying and engaging hard-to-reach populations of people with ADRD. VMC holds significant promise for improving access to specialized dementia care in geographic areas facing persistent shortages. Future research will build on this work by evaluating the VMC's long-term impact on patient- and caregiver-reported outcomes and assessing which outreach strategies provide the greatest engagement of older rural adults and their care teams. Improving access to memory care for people with ADRD in rural areas requires innovative models like the VMC coupled with a dedicated, systematic approach to implementation and outreach. All authors met criteria for authorship by providing substantial intellectual contribution to the study's conception and design (J.W., V.H.B., L.A.L.), data acquisition (J.W., V.H.B.), data analysis (J.W., V.H.B.) and interpretation (J.W., V.H.B., L.A.L.); drafting the article or revising it critically for important intellectual content and approving the final version to be published (J.W., V.H.B., L.A.L.). This research is supported through grants from the NIH/NIA R01AG068421, 1L30AG096708-01, R01AG058777, R01AG083034, and P30AG059988. The authors declare no conflicts of interest.
Woodward et al. (Thu,) studied this question.