Improving dementia assessment with the new Enhanced Services
Posted on 12 May 2014 in Healthcare / Research
Dr Chris Mimnagh, GP and Director of Strategy and Innovation for Aintree University Hospitals NHS Foundation Trust explains how he has used the touchscreen memory assessment in his surgery and how it can help to deliver their Enhanced Services targets.
The new Enhanced Services for Dementia could be seen by some practices as a potentially time-consuming, difficult waste of time. However in our practice we have been trialling the Cantab Mobile dementia screening tool over the last 12 months and so the Enhanced Services looks like a worthwhile activity with no fears for us.
This test is based on the PAL test which runs as an iPad app. The test typically takes 10 minutes and can be self-administered or ideally under supervision by a Healthcare assistant. It is valid for patients aged 50-90 years old and is expected to detect dementia at an early stage. The test also includes the Geriatric Depression Scale and a functional assessment in the form of the Activities of Daily Living questionnaire. This means the tool can provide a report on potential confounding factors.
The reports are clear; colour coded and can be exported to the patient record or onward referral.
How has the tool worked in practice?
The answer is surprisingly well. The iPad talks the patient through the test, the instructions are very clear, the test is easy to follow and although some patients have felt under pressure in terms of time, it is not a threatening experience. The iPad is supplied with a stand which avoids glare in use and of course the data is password protected and backed up when connected to a computer.
I have found the device especially useful when patients present with a concern about their memory, following on from the usual history and examination, at the time I would normally struggle to remember how to do the GPCOG or similar test, I start the patient off with the test, leave them and their concerned relative alone and return with a cup of tea. I have yet to find a patient whose vision or motor skills prevent completion of the test, but it is possible that vision may be too poor to provide a reliable result as the shapes shown are quite complex.
In patients who are concerned by memory problems the relief is obvious when the report is shared- the use of colour coding means that when things are all clear two large green bars appear within the text of the result. Amber or red appearing when there are abnormalities. The test has proved useful as reassurance when the dementia screen is green, and when mood or functional problems are highlighted the report has been a useful way of broaching the topic or reinforcing the need for further investigation.
The cost of the software and iPad is just £1,000 for a full year licence allowing unlimited assessments –given the portability of the device and ease of use it only accounts for half of the set up funding within the Enhanced Services and given the benefits, both financial and clinical, it really is money well spent.