scholarly journals Feasibility of remote Memory Clinics using the plan, do, study, act (PDSA) cycle

2021 ◽  
Author(s):  
Jemima T Collins ◽  
Biju Mohamed ◽  
Antony Bayer
Keyword(s):  
Remote Memory ◽  
Service Improvement ◽  
Attendance Rate ◽  
Memory Clinic ◽  
Improvement Project ◽  
Face To Face ◽  
Pdsa Cycle ◽  
Diagnosis Of Dementia ◽  
Memory Clinics ◽  
To Come

Abstract Introduction A timely diagnosis of dementia is crucial for initiating and maintaining support for people living with dementia. The coronavirus disease (COVID) pandemic temporarily halted Memory Clinics, where this is organised, and rate of dementia diagnosis has fallen. Despite increasing use of alternatives to face-to-face (F2F) consultations in other departments, it is unclear whether this is feasible within the traditional Memory Clinic model. Aims The main aim of this service improvement project performed during the pandemic was to explore feasibility of telephone (TC) and videoconference (VC) Memory Clinic consultations. Methods Consecutive patients on the Memory Clinic waiting list were telephoned and offered an initial appointment by VC or TC. Data extracted included: age, internet-enabled device ownership, reason for and choice of Memory Clinic assessment. We noted Montreal Cognitive Assessment-Blind (TC) and Addenbrooke’s Cognitive Examination-III (VC via Attend Anywhere) scores, and feasibility of consultation. Results Out of 100 patients, 12 had a home assessment, moved away, been hospitalised, or died. 45, 21 and 6 preferred F2F, VC and TC assessments respectively. 16 were not contactable and offered a F2F appointment. The main reason for preferring F2F was non-ownership, or inability to use an internet-enabled device (80%). VC and TC preference reasons were unwillingness to come to hospital (59%), and convenience (41%). Attendance rate was 100% for VC and TC, but 77% for F2F. Feasibility (successful consultations) was seen in 90% (VC) and 67% (TC) patients. Conclusion For able and willing patients, remote Memory Consultations can be both feasible and beneficial. This has implications for future planning in dementia services.

scholarly journals On-line memory clinic – piloting a hybrid model

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S225-S225
Author(s):  
Rahul Tomar
Keyword(s):  
Digital Literacy ◽  
Cognitive Test ◽  
Remote Memory ◽  
Limiting Factor ◽  
Memory Clinic ◽  
Improvement Project ◽  
Telephone Consultation ◽  
Face To Face ◽  
Video Consultation ◽  
On Line

AimsQuality improvement project was undertaken to reorganise memory clinic to incorporate both virtual and in-person consultation (Hybrid Virtual model), as depicted in the following model:MethodTele triage conducted to ascertain information from patient and carer. This reduced time for face to face assessment.Nurse did face to face assessment to complete cognitive test (Addenbrooke's Cognitive Examination III) & carer completed Bristol Activities of Daily Living scale. Nurse would also do BP, PR, oxygen sats & temp.Nurse discussed the assessment with the consultant (who is in the inpatient unit) on line using MS TEAMSConsultant would then see patient on line, confirm diagnosis, answer questions, give information on medication and post prescription (if required)Feedback was collected using Telehealth Satisfaction questionnaireResultHybrid remote memory clinic was started on 29/09/20. A total of 37 patients were seen in this clinic by 31/01/21.Collected feedback from 21 patients was generally positive –Information provided on video consultation prior to assessment -18 reported it as excellentHow well you privacy was respected – 21 reported it as excellent.Information you received on the treatment – 18 reported it as excellentConclusionThe hybrid remote memory clinic was more effective than telephone consultation or on line only consultation as it was –Easy to establishing rapportPhysical examination could be performedDigital literacy was no longer a limiting factorPrescribing medication was slightly more difficult but possible

scholarly journals ‘How do they want to know?’ Doctors’ perspectives on making and communicating a diagnosis of dementia

Dementia ◽  
2018 ◽  
Vol 18 (7-8) ◽  
pp. 3004-3022 ◽  
Author(s):  
Cate Bailey ◽  
Jemima Dooley ◽  
Rose McCabe
Keyword(s):  
Cognitive Impairment ◽  
Public Awareness ◽  
Memory Clinic ◽  
Training And Supervision ◽  
Diagnosis Of Dementia ◽  
Memory Clinics ◽  
The Individual ◽  
Limiting Condition ◽  
The Uk ◽  
First Time

Recent drives to facilitate earlier identification of dementia have led to increased memory clinic referrals and diagnoses. This study explored the perspectives of memory clinic doctors on making and delivering diagnoses. Four focus groups were conducted with 13 psychiatrists and two geriatricians in the UK. Transcripts were coded line by line using NVIVO. Thematic analysis identified 39 categories, 18 sub-themes and eight overarching themes. Inter-rater reliability on 31% of the data was 0.89. Increased public awareness of dementia was viewed positively in facilitating access to diagnosis and treatment. Doctors viewed diagnosis as a process and expressed concerns about limited pre-diagnostic counselling and post-diagnostic support. In diagnostic delivery doctors sought to develop a narrative drawing on the patient’s report of symptoms and adjust explanations to patient preferences and awareness. However, tailoring the delivery to the individual patient was challenging when meeting for the first time. These consultations often involved three participants (doctor, patient and relative), who were felt to have differing needs and expectations. Doctors emphasized that delicacy was required in deciding in what could be discussed in front of both parties, however also stressed the importance of explicitly naming ‘dementia’. Efforts were made to balance honesty and hope when discussing prognosis and medication. The work was sometimes emotionally distressing, with limited supervision. Existing communication training was felt to be inadequate for consultations involving triads or people with cognitive impairment. Delivering a dementia diagnosis is a nuanced and challenging task. Negotiating honest descriptions of a life-limiting condition whilst instilling hope is further complicated when cognitive impairment affects comprehension. Misunderstandings at the time of feedback may limit patient opportunities for informed future planning afforded by early diagnosis. Doctors in memory clinics would benefit from evidence based training and supervision to prepare them for these emotionally challenging and complex consultations.

scholarly journals P.019 Trends in medication use over eleven years in patients presenting to a rural and remote memory clinic

2016 ◽  
Vol 43 (S2) ◽  
pp. S25-S26
Author(s):  
R Verity ◽  
A Kirk
Keyword(s):  
Medication Use ◽  
Significant Decline ◽  
Remote Memory ◽  
Anticholinergic Medication ◽  
Memory Clinic ◽  
Rural And Remote ◽  
Anticholinergic Medications ◽  
To Come ◽  
Spearman’S Correlation ◽  
Over Time

Background: Anticholinergic and sedating medications are generally contraindicated in those with cognitive decline. We examined trends in medication use by patients presenting to a rural and remote memory clinic (RRMC) between March 2004 and June 2015 to determine whether patterns of medication use have changed. Methods: The first 445 patients seen at the RRMC between 2004 and 2015 were included in this analysis. Medication lists were collected at the patient’s initial visit, and it was noted whether patients were taking anticholinergic or potentially sedating drugs. Statistical analysis (Spearman’s Correlation) was conducted to examine trends in medication use over time. Results: Ninety-one patients (20.5%) were taking at least one anticholinergic medication. There was a statistically significant decline (25.0% in 2004 to 12.5% in 2014) in percentage of patients presenting with anticholinergic medications over the eleven years of this study (Spearman’s correlation coefficient=-0.64, p=0.035). Conclusions: The most encouraging statistic to come from this study is a decline in anticholinergic medication use in this rural population. Prescribers must be properly informed to ensure that the number of medications per patient does not continue to rise, that medications are used only as necessary, and that potentially deleterious medications are avoided.

Promoting early dementia diagnosis: a video designed by patients, for patients

2016 ◽  
Vol 29 (5) ◽  
pp. 863-867 ◽  
Author(s):  
Nina Baruch ◽  
Charlotte L. Allan ◽  
Maureen Cundell ◽  
Samuel Clark ◽  
Brian Murray
Keyword(s):  
Early Diagnosis ◽  
Small Sample Size ◽  
Small Sample ◽  
Memory Clinic ◽  
Patient Feedback ◽  
Before And After ◽  
Diagnosis Of Dementia ◽  
Memory Clinics ◽  
Advance Decisions ◽  
Level Of Understanding

ABSTRACTEarly diagnosis of dementia allows people to access effective treatment and make advance decisions while they still have capacity. We aimed to encourage people to attend memory clinic, in order to boost rates of diagnosis. We created a patient information video about Oxford Health NHS Foundation Trust Memory Clinics, to inform and empower those awaiting assessment and to promote early diagnosis.Fourteen people (patients, carers, and staff) were approached prior to developing the video to ascertain their views on the themes the video should cover. The video consisted of unscripted interviews with patients, carers, and staff. We surveyed participants and new patients attending memory clinic to get feedback on the video and to assess patients’ level of understanding and confidence about a memory assessment before and after watching the video. The video content was refined based on this feedback and a final version was produced.Patient feedback demonstrated that confidence and understanding increased after watching the video.Although this study is limited by its small sample size and lack of access to those with undiagnosed dementia, feedback suggested that the video empowered and reassured those awaiting assessment and could be used as a tool to reduce barriers to early diagnosis. Patients and carers involved in making the video found it a therapeutic activity in itself.

Preferences regarding disclosure of a diagnosis of dementia: a systematic review

2014 ◽  
Vol 26 (10) ◽  
pp. 1603-1618 ◽  
Author(s):  
Pim van den Dungen ◽  
Lisa van Kuijk ◽  
Harm van Marwijk ◽  
Johannes van der Wouden ◽  
Eric Moll van Charante ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Response Rate ◽  
Meta Analysis ◽  
Empirical Studies ◽  
Random Effects Model ◽  
Memory Clinic ◽  
Dementia Patients ◽  
Diagnosis Of Dementia ◽  
Memory Clinics

AbstractBackground:Studies in memory clinics suggest that the majority of patients would like to know of a diagnosis of dementia. It is less clear what preferences are in the community. Our objective was to review the literature on preferences regarding disclosure of a diagnosis of dementia and to assess key arguments in favor of and against disclosure.Methods:Systematic search of empirical studies was performed in Pubmed, Embase, and Psycinfo. We extracted preferences of individuals without cognitive impairment (general population; relatives of dementia patients; and physicians) and preferences of individuals referred to a memory clinic or already diagnosed with dementia. A meta-analysis was done using a random effects model. Our main conclusions are based on studies with a response rate ≥75%.Results:We included 23 articles (9.065 respondents). In studies with individuals without cognitive impairment, the pooled percentage in favor of disclosure was 90.7% (95%CI: 83.8%–97.5%). In studies with patients who were referred to a memory clinic or already diagnosed with dementia, the pooled percentage that considered disclosure favorable was 84.8% (95%CI: 75.6%–94.0%). The central arguments in favor of disclosure pertained to autonomy and the possibility to plan one's future. Arguments against disclosure were fear of getting upset and that knowing has no use.Conclusions:The vast majority of individuals without and with cognitive impairment prefers to be informed about a diagnosis of dementia for reasons pertaining to autonomy.

scholarly journals Trends in Medication Use Over 11 Years in Patients Presenting to a Rural and Remote Memory Clinic

2016 ◽  
Vol 43 (6) ◽  
pp. 815-818 ◽  
Author(s):  
Ryan Verity ◽  
Andrew Kirk ◽  
Debra Morgan ◽  
Chandima Karunanayake
Keyword(s):  
Medication Use ◽  
Remote Memory ◽  
Anticholinergic Medication ◽  
Memory Clinic ◽  
Rural And Remote ◽  
Anticholinergic Medications ◽  
The Central Nervous System ◽  
To Come ◽  
Spearman’S Correlation ◽  
Over Time

AbstractBackground: Anticholinergic and sedating medications are generally contraindicated in those with cognitive decline. We examined trends in medication use by patients at initial presentation to a rural and remote memory clinic (RRMC) between March 2004 and June 2015 to determine whether patterns of medication use have changed. Methods: The first 444 patients seen at the RRMC between 2004 and 2015 were included in this analysis. Medication lists were collected at the patient’s initial visit, and it was noted whether patients were taking anticholinergic or potentially sedating drugs. Statistical analysis (Spearman’s correlation) was conducted to examine trends in medication use over time. Results: Patients were on a mean of 5.18 medications (standard deviation, 3.46). Ninety-one patients (20.5%) were taking at least one anticholinergic medication. There was a decline (25.0% in 2004 to 12.5% in 2014) in percentage of patients presenting with anticholinergic medications over the 11 years of this study (Spearman’s correlation coefficient =−0.64, p=0.035). The prevalence of drugs acting on the central nervous system trended toward an increase, but this was not statistically significant. Sixty-three patients (14.2%) presented to the RRMC already taking a cholinesterase inhibitor. Conclusions: The most encouraging statistic to come from this study is a decline in anticholinergic medication use in this rural population. Prescribers must be properly informed to ensure that the number of medications per patient does not continue to rise, that medications are used only as necessary, and that potentially deleterious medications are avoided.

scholarly journals Quality improvement primer part 2: executing a quality improvement project in the emergency department

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 532-538 ◽  
Author(s):  
Lucas B. Chartier ◽  
Antonia S. Stang ◽  
Samuel Vaillancourt ◽  
Amy H. Y. Cheng
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Quality Improvement ◽  
Improvement Project ◽  
Emergency Department Setting ◽  
Pdsa Cycle ◽  
Time To Antibiotics ◽  
Final Article

ABSTRACTThe topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement. We will review what makes a good aim statement, the various categories of measures that can be tracked during a QI project, and the relative merits and challenges of potential change concepts and ideas. We will also present the Model for Improvement’s rapid-cycle change methodology, the Plan-Do-Study-Act (PDSA) cycle. The final article in this series will focus on the evaluation and sustainability of QI projects.

scholarly journals Impact of a blended curriculum on nursing handover quality: a quality improvement project

2021 ◽  
Vol 10 (1) ◽  
pp. e001024
Author(s):  
Xavier Losfeld ◽  
Laure Istas ◽  
Quentin Schoonvaere ◽  
Michel Vergnion ◽  
Jochen Bergs
Keyword(s):  
Educational Intervention ◽  
Patient Information ◽  
Professional Communication ◽  
Fit Indices ◽  
Negative Consequences ◽  
Improvement Project ◽  
Face To Face ◽  
Before And After ◽  
Post Test ◽  
E Learning

Context and objectiveThe negative consequences of inadequate nursing handovers on patient safety are widely acknowledged, both within the literature as in practice. Evidence regarding strategies to improve nursing handover is, however, lacking. This study investigates the effect of a tailored, blended curriculum on nurses’ perception of handover quality.MethodsWe used a pre-test/post-test design within four units of a Belgian general hospital. Our educational intervention consisted of an e-learning module on professional communication and a face-to-face session on the use of a structured method for handovers. All nurses completed this blended curriculum (n=87). We used the Handover Evaluation Scale (HES) to evaluate nurses’ perception of handover quality before and after the intervention. The HES was answered by 87.4% of the nurses (n=76 of 87) before and 50.6% (n=44 of 87) after the intervention. Confirmatory factor analysis was used to assess the validity of the HES.ResultsThe original factor structure did not fit with our data. We identified a new HES structure with acceptable or good fit indices. The overall internal consistency of our HES structure was considered adequate. Perception of nurses on Relevance of information showed a significant improvement (M=53.19±4.33 vs M=61.03±6.01; p=0.04). Nurses also felt that the timely provision of patient information improved significantly (M=4.50±0.34 vs M=5.16±0.40; p=0.01).ConclusionThe applied intervention resulted in an improved awareness on the importance of Relevance of information during handovers. After our intervention, the nurses’ perception of the HES item ‘Patient information is provided in a timely manner’ also improved significantly. We are aware that the educational intervention is only the first step to achieve the long-term implementation of a culture of professional communication based on mutual support.

scholarly journals Assessment of memory complainers in São Paulo, Brazil: Three-year results of a memory clinic

2008 ◽  
Vol 2 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Cássio Machado de Campos Bottino ◽  
Pedro Zucollo ◽  
Maria Del Pilar Quintero Moreno ◽  
Gislaine Gil ◽  
Carla Garcia Cid ◽  
...  
Keyword(s):  
Clinical Work ◽  
Cognitive Disorder ◽  
University Hospital ◽  
Memory Clinic ◽  
Cognitive Complaints ◽  
Outpatient Group ◽  
Memory Clinics ◽  
Icd 10 ◽  
The Usa ◽  
Primary Care Doctors

Abstract Memory clinics were established in the USA and European countries as services to attend patients who complain of cognitive deficits, referred by primary care doctors, specialists and other hospitals. Objective: We aimed to describe the clinical and cognitive profile of consecutively evaluated subjects during the initial three years of service of a memory clinic from a university hospital. Methods: Subjects were submitted to a clinical work-up for dementia, which included laboratory exams, cranial computerized tomography, cognitive tests, and a comprehensive neuropsychological battery. Diagnosis was made according to ICD-10 criteria. Results: We evaluated 104 subjects (67.3% females and 32.7% males), with mean age of 59.1 years, 88.8% aged 50 years or above. Mean schooling was 9.9 years. Patients were classified into 10 different primary diagnostic categories, namely Depression (26.9%), Alzheimer's disease (17.3%), Memory complaints without objective impairment (17.3%), Mild Cognitive Disorder - MCD (14.4%), and Anxiety (12.5%) the most frequent diagnosis. Comparing patients with dementia, MCD, Depression or Anxiety and Memory complainers, by age (below and above 60 years), dementia was more commonly diagnosed in older subjects, while a higher frequency of memory complainers was found in the younger group. Conclusions: This preliminary report from an outpatient group of referred patients with cognitive complaints showed a higher frequency of psychiatric disorders in this sample. The memory clinic approach should be considered as a model of service which can evaluate subjects with cognitive complaints effectively and improve the quality of care delivered to this patient group.

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