A coaching tele-consultation service to improve care for behavioral and psychological symptoms of dementia: A pilot study

Abstract

Background Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent in major neurocognitive disorders and have considerable impacts. Many clinical settings struggle with insufficient knowledge, suboptimal management and excessive use of psychotropic medications. Research aim Given the low availability of specialized staff and the remoteness of some healthcare locations, our aim was to document the effects and the implementation process of a telehealth coaching service on BPSD care. Methods Geriatric specialists at the Institut universitaire de geriatrie de Montreal (IUGM) offered a structured training program to distant community care teams through tele-consultation. It involved setting up a BPSD team in each participating community to ensure acquired skills would be sustained. The program proposed a 2-day formal training followed by a monthly complex BPSD case tele-consultation. One of these clinical projects with the Magdalen Islands health centre (MIHC) included a mixed methods research component. We evaluated clinical benefits by comparing Neuropsychiatric Inventory (NPI-Q), Clinical Global Impression (CGI-I) and psychotropic intake at baseline and three months post tele-consultation, on clinical chart review with non-parametric Wilcoxon analysis. The implementation process was evaluated by open-ended interviews and satisfaction questionnaires. The qualitative data were analyzed using Miles and Huberman's approach. Results Twelve patients were evaluated by tele-consultation. Results showed clinical benefits (decrease of 35% NPI-Q (p=0.024), an improvement on CGI, as well as high satisfaction levels (caregivers and remote team). Eleven open interviews were completed (2 nurses, 3 psychosocial staff, 2 managers, 4 doctors). The project helped to define a better care trajectory for BPSD. Professionals felt a sense of competency and relief from helplessness and isolation. They also described improved patient care (systematic evaluations, individualized interventions integrating non-pharmacological aspects, more appropriate prescriptions). Conclusion These results suggest that tele-consultation is a good way to disseminate expertise concerning BPSD.