Care Before Crisis - Diagnosing Dementia in the Primary Setting
Posted on 16 October 2015 in Healthcare
Dementia Nurse / Study Co-ordinator Helen McBryer looks at cognitive testing and image analysis in the community setting as part of The Brain Health Centre project.
The NHS is known to be under intense pressure in its provision of care to an increasingly older pouplation. With spiralling costs and the widespread prevalence of dementia, urgent steps are needed to address the global dementia challenge.
Having worked in both primary and secondary care throughout my nursing life, and with a bias towards community nursing (allowing the patient to live well for longer at home) I have long felt the frustration of patients being admitted to hospital at crisis point.
When patients present at hospital, often as a result of a fall, complex co-morbidities or failure to cope at home, the presence of possible dementia often rises to the surface. It is at this point that opportunities for interventions and care planning for undiagnosed patients are lost. Key challenges once a patient has arrived at this point of care are the need for fast and accurate diagnosis of dementia which is a huge task in overstretched, ill-equipped wards.
Making the most of our Memory Assessment Services (MAS) is key to preventing these crises scenarios where patients can move from Medical, to Psychiatric and to Social services haphazzardly and under pressure.
The community pilot study gained its funding from The Technology Strategy Board in order to introduce an innovative digital healthcare platform that translates industry-leading cognitive testing and brain image analysis technology into the primary setting. It provides a decision support tool for timely diagnosis of dementia, which fits into clinical workflow and provides actionable information, accessed at MAS by clinicians who have the time and understanding to diagnose patients and support them thereafter.
The study and use of technologies is beneficial for a number of reasons:
- Sensitive to the detection of Mild Cognitive Impairment (MCI) and early signs of dementia
- Ease of administration of cognitive assessment can save time for practitioners
- Reassures patients and facilitates timely intervention for better patient outcomes
- Provides information that can determine depression or delirium rather than dementias
- Patients receive the initial assessment in their own homes
- Looks at accurate diagnosis through brain imaging as opposed to diagnostic exclusion
- Identifies patients with differential diagnoses to be referred to specialist consultants
- Shortens time to diagnosis
- Cost effectiveness of timely diagnosis
- Planned care rather than ‘urgent’ care
Having undertaken the role of Study Co-ordinator and Dementia Nurse for this pilot study I have met patients and carers who have decided to participate in the study to enable them to reach diagnoisis, no matter how devastating this could potentially be. Some of the reasons for participating have been social (e.g. whether to move closer to family for support), to relinquish a driving licence, or if an accurate diagnosis would avoid the distressing admissions to the acute psychiatric units at crisis points. Others have been ‘I just want to know what is wrong with me’, ‘am I going mad’ and ‘am I really ill or is there something I can do about this?’
Reaching patients and carers who are suffering in silence until they are finally able to express concerns to their GP rather than in a chaotic A&E is a model that I hope will translate across the wider NHS. Facilitating diagnosis and interventions at this primary stage has to be better, both economically and for the patients and their families.
For more information on the MAS Digital Technologies Pilot Study in East Sussex Clinical Commissioning Groups please contact Helen.