Grampians takes a regional approach to dementia care

Last year, Grampians Medicare Local in Victoria launched an online dementia pathways tool to support local primary care clinicians with timely referrals to specialist services and local support options for people with dementia.

As part of the Grampians Region Community Aged Care Dementia project, the tool differs from others such as those used in NSW's Hunter New England region and western Sydney in that it is open to people living with dementia and their carers to use.

GPs and community nurses are the prime audience, however, and the tool has been developed using a range of clinical content developed by Mark Yates, a consultant physician in geriatric medicine and head of the Cognitive Dementia and Memory Service (CDAMS) at Ballarat Health Services.

It is based on technology developed at Federation University Australia’s (previously University of Ballarat) Centre for eCommerce and Communications (CeCC), which has worked with Grampians Medicare Local and its predecessor as a division of general practice on an online mental health tool.

According to regional dementia project officer Carolyn Gargiulo, the spark for the development of the tool began following a consultation period with HACC-funded and specialist service providers on what could be done to improve dementia services in the area.

What that consultation found was that there was a lack of a clear pathway for people with dementia and their carers in finding services for better care, and that many people first presented at healthcare services when they were at a crisis point.

Ms Gargiulo also conducted a survey of local GPs and practice nurses, and found that half of them admitted that their background in dementia care was fair or limited.

“They were very honest in their responses,” she said. “GPs are expected to know so much but diagnosing dementia is very complex, and then they get to a stage where they are not sure of the next step.

“When you're looking at dementia, it is a stigmatised condition and we all know that diagnosis is not timely enough. This project was aimed at working with GPs and primary health care providers to raise their awareness and was complementary in raising community awareness as well. This pathway has got something for everyone.”

In addition to providing information on local services such as clinical assessment and referral services, government-funded aged care programs like the Home and Community Care (HACC) Living at Home Assessment and Aged Care Assessment Service, and respite and carer support groups, the pathway is designed to assist GPs with early intervention, diagnosis and ongoing management of patients with dementia.

It also provides evidence-based advice and guidance on areas such as pharmacological interventions, palliative care and end-of-life care planning.

As part of the consultation period, Ms Gargiulo spoke with Grampians Medicare Local and the CeCC about developing an online tool, and also with Professor Yates about what information to include from a clinical perspective.

CeCC systems analyst programmer Scott Limmer said the system was built on top of the centre's custom-built content management system, which has the flexibility to be able to be customised to suit any end product.

The centre's director, Helen Thompson, said the dementia pathway complements other healthcare work that the CeCC has worked on, including in mental health and cancer, and it had the potential to be customised for other regions and purposes.

“There is precedent in other work that we do for the same content to be available through different doorways; online doors if you like,” Dr Thompson said.

“The beauty of this pathway is that it is accessible to all of the key stakeholders in the area, not just to GPs and to practice nurses. It is available for regional nurses across the region, but also the carers or people with dementia themselves. They can also access the website and take advantage of the information available to them.”

Ms Gargiulo said one of the aims of this project was to provide assessment and screening tools not currently available to GPs through their own software, and to guide clinicians in providing appropriate referrals not only to specialist healthcare services but to social services such as Meals on Wheels.

“There is that social isolation that comes with dementia, and in our survey, we found that there were extremely low levels of referrals to Alzheimer's Victoria, care respite support services and HACC services,” she said. “You would be surprised how many people, when they see the acronym HACC, don't know what it is.

“This pathway ensures that people with dementia and their carers are linked to support services so they can be better educated on the disease and know how to live with it well.

“If they were to access the pathway, they would have at their fingertips all of that information to know where to go locally to get that support. We make the recommendation to get that support to reduce carer stress and burden and also to engage the person with dementia in meaningful activities as well to reduce behaviours.”

Grampians Medicare Local is currently promoting the resource through face-to-face meetings with local GPs, and the plan is for the Ballarat Health Service's GP liaison unit to upload it to its website, Ms Gargiulo said.

“They have a new referral form into Ballarat Health Service so that we are linking it as well. There will be links on the Central Highlands Primary Care Partnership website as well, and certainly in my role we will be promoting it to the HACC and Aged Care Assessment Teams and officers as a resource.”

Grampians Medicare Local CEO Andrew McPherson said he hoped to help develop more of these types of tools in other areas over time.

“Another area that we think would benefit strongly from this type of approach is mental health,” Mr McPherson said. “We put together a mental health tool some years ago and it's now ready for us to take a look at it again in the new Medicare Local environment and see if we can't develop that in a similar way to the dementia pathway.”

The Grampians Medicare Local is also working to expand its telehealth services, including taking part in a trial with the University of Melbourne and the Royal Flying Doctor Service on a telehealth project for dental screening in aged care facilities.

“We promote telehealth quite widely across our region because again, it is an access issue,” Mr McPherson said. “There are so many of our people who have to travel three, four or five hours.”

It is also working with GPs and allied health practitioners to improve on what Mr McPherson said was already a strong uptake of secure messaging, and is hoping to work with some of the local hospitals to get electronic discharge summaries flowing to local GPs.

In terms of the PCEHR, he said the Medicare Local was strongly promoting the system and is seeing some good uptake at both the provider and consumer level.

“One of the challenges with the PCEHR of course is that it is only clinically useful if everybody is on it,” he said. “Locally, we are working with Federation University Australia and a number of hospitals, some software providers and others to come up with a region-wide approach, because with eHealth, particularly in a regional area, you end up with a lot of technology that doesn't necessarily talk to each other.

“You really do have to have a region-wide approach. We decided some time ago that this was the only way forward. We have really got a strong groundswell of interest, and I think everyone in the health system realises how many opportunities have been lost over the years, and we are now working together as a region.”

Posted in Aged Care

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