Could Telemedicine Improve Neurocognitive Disorders Detection and Diagnosis in Nursing Homes? - European Medical Journal
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Could Telemedicine Improve Neurocognitive Disorders Detection and Diagnosis in Nursing Homes?

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2 Mins
Authors:
Armelle Leperre-Desplanques,1 Audrey Maillet,1 Isabelle Hauger,2 Antonis Politis,3 Shima Mehrabian,4 Sylvain Gaulier,1 Leslie Cartz-Piver,1 Bertrand Fougere,5 Pierre Krolak-Salmon1
Disclosure:

The authors have declared no conflicts of interest.

Acknowledgements:

The authors would like to thank the teams and residents from the nursing homes that participated in the experiment: Alexandrovska, Bulgaria; Le Bourgailh, Les jardins de Leysotte,  France; Aktios Odigos, Ippokratelo Therapeutirio,  Stavridio, Greece. This document is part of “ACT ON DEMENTIA” Joint Action ‘678481/DEM2’ which has received funding from the European Union’s Health Programme (2014-2020).

Citation
EMJ Neurol. ;8[1]:59-61. Abstract Review No. AR13.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

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In Europe, there is a lack of detection of neurocognitive disorders (NCD) in primary care, particularly in nursing homes. Obstacles in nursing homes include general practitioners’ limited time, unawareness of diagnosis guidelines and tools, and difficulties to refer patients who are disabled to NCD specialist doctors. Telemedicine (TLM) could improve access to specialist doctors and increase NCD diagnosis.

In the context of the “Act On Dementia” European Joint Action, three countries (Bulgaria, France, and Greece) tested TLM for NCD detection and diagnosis in six nursing homes (one in Bulgaria, three in Greece, and two in France). NCD detection tools for patients were shared as well as satisfaction and dementia attitude questionnaires for nursing homes staffs. The experiments were planned from April 2018 to June 2018.

The six nursing homes were faced with various legal, ethical, and practical requirements before TLM could be implemented. Results at 3 months varied. In Greece, the nursing homes’ staffs were trained about NCD via a 30-hour tele-educational programme. In France, despite altered Mini-Mental State Examination (MMSE) scores and current TLM for behavioural disorders (behavioural and psychological symptoms of dementia [BPSD]), there were few requests for NCD diagnosis, probably a result of unawareness of diagnosis benefits for nursing homes’ residents. In Bulgaria, nursing homes’ staff training and 17 teleconsultations for NCD diagnosis took place and led to mild-to-major NCD diagnosis, including aetiological diagnosis in 16 cases. Despite the challenges, all the nursing homes‘ teams were satisfied with TLM. The dementia attitude scale results were similar between the different nursing homes, countries, and health professionals and other nursing homes’ professionals.

Each country identified facilitators to improve NCD diagnosis in nursing homes, e.g., a shared tool explaining the benefits of NCD aetiological diagnosis for nursing homes’ patients (Table 1) to be included in the NCD educational programme for nursing homes’ staff and general practitioners, which represents a crucial step for a successful TLM programme.The first request for TLM for NCD in nursing homes was for BPSD; NCD detection and diagnosis in nursing homes could be improved by TLM when combined with BPSD evaluation.

Table 1: Benefits of neurocognitive disorders aetiological diagnosis for nursing homes’ patients: a tool proposed by « ACT ON DEMENTIA » to support neurocognitive disorder diagnosis in nursing homes.2

BPSD: behavioural and psychological symptoms of dementia; NCD: neurocognitive disorder; NH: nursing home.

References
Act On Dementia European Joint Action. Report on testing evidence-based examples of best practices in detection and diagnosis of neurocognitive disorders. 2019. Available at: https://www.actondementia.eu/sites/default/files/2019-12/AoD_WP4-D2%20FINAL%20REPORT%20excluding_Appendices.pdf. Last accessed: 28 May 2020. Act On Dementia European Joint Action. Report on the benefits & risks of neurocognitive disorders diagnosis. 2017. Available at:  https://www.actondementia.eu/sites/default/files/2018-02/Work%20package%204%20-%20Report%20on%20the%20Benefits%20and%20Risks%20of%20%20%20%20%20Dementia%20Diagnosis. compressed.pdf. Last accessed: 01 July 2020. Shores MM et al. Identifying undiagnosed dementia in residential care veterans: comparing telemedicine to in-person clinical examination. Int J Geriat Psych. 2004;19(2):101-8. Catic AG et al. ECHO-AGE: an innovative model of geriatric care for long-term care residents with dementia and behavioral issues. J Am Med Direct Assoc. 2014;15(12):938-42. Brignell M et al. The application of telemedicine to geriatric medicine. Age Ageing. 2007;36(4):369-74.