Objective: To describe innovative strategies to enhance psychogeriatric services in a large rural area, using community-based teams and a videoconferencing telehealth network.
Design: Descriptive study.
Materials and Methods: Southwestern Ontario, Canada, is a large (16,000 square miles) and primarily rural 10-county region with approximately 200,000 persons over the age of 65. Geriatric psychiatry services and other specialized geriatric resources are limited, and primarily based in urban centers. Frail older persons are often unwilling or unable to travel long distances necessary to receive specialized care. To address these challenges, psychogeriatric services have played a partnership role in the development and implementation of 2 regional networks. The first is a regional network of 9 county-based community assessment teams – the Southwestern Ontario Geriatric Assessment Network - established through the blending of existing services with new resources. Most local teams include one to three clinicians, generally a resource nurse, a part-time physician, and an educator from the Alzheimer Society. Teams provide local education, consultation, networking and assessment services focused on improving the health status of older persons with complex medical, psychiatric, functional and psychosocial problems. Education, mentoring and consultation in geriatric and psychogeriatric assessment and intervention are provided by regional specialized geriatric services. Education, consultation, communication and networking opportunities are being facilitated through the development of a second network – the Southwestern Ontario Telehealth Network (SWOT-N). SWOT-N is a forty-site, hospital based, videoconferencing telehealth network, designed to develop and extend clinical, educational and administrative programs and linkages across the region. Specialized psychogeriatric services and local SWOGAN teams have used SWOT-N for educational workshops, indirect case conferencing, and other administrative and networking opportunities.
Results: The assessment and videoconferencing networks have provided opportunities for specialized psychogeriatric consultation and education for community assessment teams across the region. The networks support shared learning and innovation, and the ongoing dissemination of best practice information. The networks provide vehicles for enhanced communication and networking among the county-based teams and regional programs, and have helped to develop new relationships among local programs and tertiary services. Challenges include the clarification of local and regional roles and responsibilities, as well as the development of strategies to ensure consistent quality in the context of staff turnover and resource constraints.
Conclusion: Innovative use of regional geriatric assessment and videoconferencing networks have enabled more efficient use of specialized psychogeriatric resources as well as the development of community-based resources that can provide consistent, accessible and locally-responsive services.
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