An Integrated Psychogeriatric Care paradigm in Greece

Abstract

Backround : Elderly are frequently afflicted by more than one pathological condition and are more vulnerable to dementia and depression, diseases that are of chronic nature and require repeated monitoring. Such patients face the greatest difficulties to gain access to mental health care services. In the context of an integrated care project, the 1st Department of Psychiatry developed a tele-psychogeriatric service, consisting of a tele-psychogeriatric unit (T-psyGU) and a mobile tele-psychogeriatric unit (MT-psyGU) for home care services. The aim of this program was the delivery of diagnostic, therapeutic and educational approaches to demented or depressed patients and their families, that live in remote and underserved areas, through the implementation of new technology in the geriatric mental health care delivery system and to connect health care services provided by different sources. Methods : - Setting: rural and urban underserved areas ( Andros Island) - Staffing: social workers and GP supervised by geriatric psychiatrists based at Eginition Hospital - Intervention: standard protocols to screen, identify and treat depression, dementia and BPSD - Technology: iPad and android technology able to transmit and receive patient’s image and data of psychometric testing. The resulting application is a standalone tool that contains all the pre-existing tests which are useful for the health care professionals visiting a remote patient. Access to Wi-Fi network allows the synchronization of each patient’s data into a central system, accessible to accredited personnel. - Health care services connected: Health care Center, Home care, Social Services, Mobile Psychiatric Unit, Local GP’s - Outcome measures: number of new cases, use of psychotropic drugs, visits to hospitals, suicide prevention, number of health care services connected, follow up visits. - Funding: 2012-2013 Stavros Niarhos Foundation (SNf). From 2013-2015 Andros island Charities Results : During 2012-2015, 198 patients with depression and/or dementia were monitored with more of 889 videoconference appointments. 7 patient admissions were arranged. Compared to previous usual care, the intervention resulted in better recognition of psychiatric symptoms, better use of psychotropic drugs and less use of antipsychotics or sedative–hypnotics, better follow up, fewer visits to tertiary care were recorded and faster resolution of suicidal ideation. Caregivers showed improvement in distress and they expressed their satisfaction about the new service. There were an improvement in connecting Health care services mostly with social services, tertiary health care services and Health center. Conclusions : The successful application of this integrated collaborative service through communication technology in geriatric mental health care offers the opportunity to mental health specialists to reach elderly people in remote areas and to connect different health care services. It seems that, Andros could be a working paradigm of an evolving integrated psychogeriatric care service.