The Saskatchewan approach to rural and remote dementia care ANDREW - - PowerPoint PPT Presentation

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The Saskatchewan approach to rural and remote dementia care ANDREW - - PowerPoint PPT Presentation

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The Saskatchewan approach to rural and remote dementia care ANDREW KIRK MD, FRCPC UNIVERSITY OF SASKATCHEWAN PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015 Why is there a problem? 1 . Prevalence of dementia increasing. 2. Large

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The Saskatchewan approach to rural and remote dementia care

ANDREW KIRK MD, FRCPC UNIVERSITY OF SASKATCHEWAN

CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015 PRESENTER NAME

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Why is there a problem?

  • 1. Prevalence of dementia increasing.
  • 2. Large rural population (Canada 30%; SK 49%)

with access problems.

  • 3. Large older population in SK (14.6%).
  • 4. Seniors more likely to live in rural areas.
  • 5. Large geographic area (1 million people in

652,000 sq. km).

CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015 PRESENTER NAME

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Saskatchewan is a big place with few people

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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Strategy for AD & Related Dementias in SK (2004)

“It was like climbing a mountain to get a diagnosis.”

  • Focus group comment.

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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THE GOAL

To develop and evaluate a streamlined interdisciplinary “one-stop shopping” clinic for patients from rural and remote Saskatchewan for diagnosis and management

  • f dementia and to evaluate telehealth as a

means of delivering follow-up care to patients and their families

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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INITIAL TELEHEALTH VISIT WITH BLOODWORK

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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CLINIC DAY (THEN)

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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NOW

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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CLINIC DAY

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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CLINIC DAY

Joint and individual assessments by neurologist, neuropsychologist, physiotherapist, dietitian. Neuro-imaging

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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Original Buschke Cued Recall Test

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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Pictorial Prairie Buschke

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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END OF CLINIC DAY

Inter-disciplinary meeting of all professionals involved with family doctor on telephone. Meeting with patient and family to discuss diagnosis, treatment.

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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CLINIC DAY

1700: Patient and family head home.

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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STEP 4 – FOLLOW-UP

6 Weeks 12 Weeks 6 Months 12 Months OR

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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WHO DO WE SEE?

Alzheimer’s Disease 194 43.6 Mild Cognitive Impairment 68 15.3 Normal 60 13.5 Frontotemporal Dementia 46 10.3 Lewy Body Dementia 22 4.9 Vascular Dementia 20 4.5 Vascular/Alzheimer’s Dementia 12 2.7 Head Injury 5 1.1

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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Travel saved by Telehealth (km per round trip) (n=363)

Mean distance to Telehealth = 71 Mean distance to Saskatoon = 529 Distance saved by Telehealth = 458

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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Family/Patient Satisfaction with Telehealth

Would you use Telehealth again? Yes: 100% Would you recommend Telehealth to another person? Yes: 97%

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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Satisfaction with Appointments (n = 58)

Mean (SEM) Min Max F(1,56) p

TH

4.66 (0.11) 1 5 2.05 0.158

IP

4.48 (0.09) 3 5

1 = very dissatisfied, 5 = very satisfied No difference in satisfaction

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Convenience of Appointments

(n = 58)

Mean (SEM) Min Max F(1,56) p

TH

4.78 (0.08) 3 5 37.78 < 0.0001

IP

3.76 (0.15) 2 5

1 = very inconvenient, 5 = very convenient Telehealth significantly more convenient

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Can Cognition be Followed

  • ver Telehealth?

Mini-mental Status Scores (N = 71) In-person: 22.34 +/- 6.35 Telehealth: 22.70 +/- 6.51

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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FUNDING

Then: CIHR-funded research project Now: Funded directly by provincial government

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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A GLIMPSE TOWARD THE FUTURE

Working with rural and remote health regions to streamline and improve the journey for those with dementia and their families.

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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CONCLUSION

A multi-disciplinary “one-stop shopping” Rural and Remote Memory Clinic with telehealth follow-up is a convenient, valid, effective, and transferrable way to improve the care

  • f those with dementia and their

families.

PRESENTER NAME CAHS FORUM ON DEMENTIA SEPTEMBER 17, 2015

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