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Enhancing Early Diagnosis and Culturally Sensitive Support and Care of Dementia

Dr. Leena Jain &Dr. Peter O’Connor

Geriatricians, Project Co-LeadsQuality Forum 2019

Funding for this initiative was provided by the Specialist Services Committee (SSC), one of four joint collaborative committees representing a partnership of Doctors of BC and the BC Ministry of Health.

Acknowledgement

Funding for this initiative was provided by the Specialist Services Committee (SSC), one of four joint collaborative committees representing a partnership of Doctors of BC and the BC Ministry of Health.

Disclosure and Conflict Management

No affiliation (financial or otherwise) with a commercial organization.

Background

▪ Dementia is a complex disease requiring a multifaceted interdisciplinary approach involving a range of health care professionals (specialist and primary care).

▪ The challenges of diagnosing and supporting people with dementia and their families and caregivers are expected to increase as prevalence rates in Fraser Health (FH) are anticipated to rise by 72% over the next 10 years (from 16,128 cases in 2009 to 27,749 cases in 2024).

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▪ This challenge is further compounded by FH’s large South Asian community who may be at greater risk due to increased prevalence of cardiovascular risk factors.

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▪ Evidence suggests that dementia, especially in early stages, remains under-detected, under-diagnosed, under-disclosed, and under-treated/managed.

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▪ This may be magnified in the South Asian community due to the cultural context, perceptions, and knowledge of aging and dementia; stigma; and access to culturally sensitive services.

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▪ Many primary health care practitioners report a lack of confidence and the skills required to provide a diagnosis of dementia.

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▪ Educational and interdisciplinary consultation support from specialists such as geriatricians, geriatric psychiatrists and neurologists have the potential to support improvements in early diagnosis.

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Gaps in Dementia Care

▪ Receiving an early diagnosis of dementia will:

▪ Result in earlier treatment which is proven to be more effective for maintaining quality of life

▪ Gain earlier access to dementia information, support and services

▪ Allow time to plan for the future

▪ Reversible dementia: there are certain, treatable conditions such as vitamin B12 deficiency, low thyroid, depression among others which present as early dementia and should be diagnosed early as possible.

Early Diagnosis and Management

Early Dementia Strategy

▪ Launched in 2015, our goal was to enhance the role of specialists in supporting primary care practitioners to increase their knowledge and confidence in early diagnosis and culturally sensitive treatment and management of people with dementia and their families.

Key Streams

Early Dementia Strategy

Integrated, interprofessional

collaborative practice guideline/pathway

Competency-based dementia education

program

Development of culturally-sensitive

resources focusing on South Asian population

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This overarching goal was being achieved through the development and implementation of activities in three key streams:

Collaborative Practice Dementia Pathway

Milestones Achieved:

✓ Pathway content developed by interdisciplinary team

✓ Pathway designed as an interactive PDF, to be uploaded to desktop/EMR with relevant links

✓ Finished pilot testing of Pathway in Education Mentoring Program

✓ Collected user feedback on format and utility

✓ Evaluation conducted after 8-month pilot (*details next slide)

A Brief Summary of the Evaluation:Dementia Mentoring Education – Dementia Pathway

• Majority of mentees used the Collaborative Pathway and found it useful.

• Integration of the Pathway with EMR had been suggested a number of times.

– Preferred EMRs are: 1. Profile 45% 2. Oscar 35% 3. MedAccess 15%

Collaborative Practice Dementia Pathway

Milestones Achieved:

✓ Finalized and integrated Pathway into MedAccess(goes live on Jan 6) and OSCAR EMRs

✓ Uploaded onto Pathways BC

✓ Pathway Integration into Profile going forward through Primary Care Profile EMR Steering Committee

✓ Continuing to scale up and spread implementation regionally (other 7 Divisions)

Screenshot of Dementia Pathway use in MedAccess EMR

Dementia Education Mentoring Program

Milestones Achieved:

✓ Designed and developed in partnership with UBC CPD

✓ CME Accreditation (40.5 Mainpro+ credits)

✓ Mentor Training Session on Sept 12, 2017

✓ Program Kick-Off Meeting held on Sept 25, 2017

✓ Program’s first cohort finished in May 2018

✓ Final Reflection and evaluation (*details next slide)

Kick-off Event, September 25th, 2017 in Surrey, BC

A Brief Summary of the Evaluation:Dementia Mentoring Education

• 95% of primary care providers who participated in the dementia education program observed positive changes specifically in the following areas: early recognition of dementia, more systematic patient visits and increased confidence in using tools, (i.e. sMMSE, MoCA, and community services).

• 86% of the specialist mentors felt that referral practices have significantly improved

• A couple of testimonials:

– “Thank you for the program, the design, the management and the dedication of our mentor. I appreciate this very much “

– “I thoroughly enjoyed being a mentee in this program and would highly recommend participation to my fellow colleagues if the program was offered in the future”

❑ Unable to identify an immediate commitment to run the program again due to funding constraints

Culturally-Sensitive ProgramMilestones Achieved:

✓ The Alzheimer Society of BC has committed to sustaining the Punjabi-speaking South Asian Support And Education Coordinator (South Asian Dementia Helpline: 604-449-5003, M-F 9am-4pm) at least through 2019

✓ Developed Punjabi MoCA with instructions available on mocatest.org, and other culturally-sensitive tools and resources

✓ Free webinars about the Punjabi MoCA and culturally-sensitive dementia care for the South Asian Community online at FH website

✓ Public awareness campaign, media engagement strategy (*details next slides)

Culturally-Sensitive ProgramMilestones Achieved:

Translated dementia resources developed will leave a lasting legacy in the South Asian Community. The following resources are being housed on the external Fraser Health website:

• South Asian Cultural Sensitivity Webinar Slides• 7 Numbers for Early Dementia • Keep your Brain Healthy brochure • HandyDART Simplified Instructions • iCON Getting to know Dementia Booklet

(South Asian edition releases 2019)*English, Punjabi, & Hindi versions

To be uploaded to FH Internal Website:• Punjabi MoCA• Dementia Pathway

Public Awareness Campaign

▪ News Release (Nov 14, 2017)

▪ Interviews: Black Press network of lower mainland community papers, Omni Television, Channel Punjabi/Zee TV, Asian Pulse, Lashkara, and Spice Radio Show

▪ Newspaper Articles: Dementia series concluded (4 articles completed)

▪ Podium Talks: Gurdwara Sahib Brookside (November 5, 2017) and Laxmi Narayan Mandir (November 26, 2017)

Public Awareness Campaign

▪ Dementia Workshop to Seniors Group at LaxmiNarayan Mandir (Jan 27, 2018)

▪ Icon Healthy @ Home Forum (March 4, 2018)

▪ ASBC ‘Understanding Dementia’ workshops presented by Baljeet Judge (March 13 and April 11)

▪ In-services to New West Seniors Clinic, Gateway and Newton Home Health (March 15, April 24, and April 26)

▪ Geriatric Services Conference (April 6, 2018)

▪ Aging Poster Display presented by ASBC (April 13)

▪ Physician Resource Fair at Surrey City Hall (May 2)

Public Awareness Campaign

▪ Family Medicine Conference (November 2 & 3)

▪ FH Dementia Forum for South Asian community at Grand Taj Banquet Hall (November 25)

▪ CESBC Evaluation Conference (November 30)

▪ Public Campaign Conclusion (December 31)

Results: Post-talk surveys

▪ After the talks, the attendees stated:

✓97% understood that they should talk to their doctor if anyone in their family or in themselves have signs of dementia,

✓82% increased their knowledge of risk reduction for themselves and their family, and

✓84% understood how to get information regarding dementia if needed.

"very knowledgeable, now I know, what my sister is going through. THANK YOU, You guys are doing a great job"

"Well thought out and beautiful, had a mix of good examples and information.”

“Excellent talk, great knowledge, great communication style”

Lessons learned and success strategies

▪ Engage the target audience in the design and development of the project

▪ Mentorship model can achieve positive outcomes but is resource-intensive to administer on an ongoing basis

▪ Culturally-sensitive public talks with timely advertisements are effective ways of getting the message out regarding dementia in SA communities