Telemedicine Intervention for Neuropsychiatric Symptoms in Long-term Care Facilities

The DETECT study (Dementia in long-term care facilities: telemedicine for the management of neuropsychiatric symptoms) is being conducted over 24 months in 20 facilities to evaluate the acceptability of telemedicine intervention in real-world settings.

Among people in long-term care facilities who have dementia, 80% exhibit neuropsychiatric symptoms, and managing these symptoms presents a challenge to clinicians and long-term care facility staff because there are currently no safe and effective drug treatments. Researchers of the DETECT study will assess the potential for future implementation of telemedicine consultation to manage neuropsychiatric symptoms in long-term care facilities.

DETECT expects to enroll approximately 200 patients with disruptive neuropsychiatric symptoms. The control group will receive usual care and an intervention group will receive telemedicine consultation. Data will be collected at baseline, at the 1-month mark, and at the 2-month mark.

The primary outcome measure is the acceptability of telemedicine among long-term care facility staff, using quantitative indicators including the proportion of telemedicine solicitation among patients, the time it takes to obtain a telemedicine consultation, and the number of staff participants in each consultation.

Qualitative indicators will include collective semistructured interviews conducted by sociologists assessing the staff’s overall satisfaction and inclination to adopt telemedicine in everyday clinical practice. Secondary measures will include the rate of hospitalization and consultation as a result of disruptive neuropsychiatric symptoms, psychotropic drug use, health costs, and patient quality of life.

Two anticipated limitations are insufficient follow-up time for a thorough analysis of the clinical effectiveness of the intervention and insufficient total study duration to assess organizational factors and health costs.

The researchers hypothesize that “telemedicine may provide assessment and optimal care to long-term care facility residents who may not have easy access to specialized services on short notice. Telemedicine may provide a more suitable solution than the usual care.”

This intervention can further assist long-term care facility staff by enhancing training and facilitating a better understanding of determinants of neuropsychiatric symptoms. Moreover, telemedicine can aid in identifying underlying causes of conditions and creating personal and global treatment plans with long-term care facility staff.

Reference

Piau A, Nourhashemi F, De Mauléon A, et al. Telemedicine for the management of neuropsychiatric symptoms in long-term care facilities: the DETECT study, methods of a cluster randomised controlled trial to assess feasibility. BMJ Open. 2018;8:e020982.