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Telemedicine in the management of neuropsychiatric symptoms (NPSs) among older patients with dementia residing in long-term care facilities (LTCFs) is equally effective compared with usual care as relates to hospitalizations and psychotropic drug prescription, according to study findings published in The American Journal of Geriatric Psychiatry.
Telemedicine in primary care in LTCFs among older populations reduces emergency room visits and unscheduled hospitalizations, and has been shown to preserve quality of life. Researchers in the current study compared telemedicine in NPS management vs usual care among patients with dementia living in LTCFs.
Secondary and exploratory analyses were conducted using data from DETECT, a randomized, prospective, multicenter, controlled cluster pilot study comparing a telemedicine interventional arm for NPS management with usual care (control arm). DETECT included 141 patients (n=76 interventional; n=65 control) in 19 LTCFs enrolled between June 2015 and October 2017 with 2-month follow-up. Analyses were conducted on a modified intention-to-treat population. Patients were treated at Toulouse University Hospital, Toulouse, France (coordinator) or Limoges University Hospital, Limoges, France.
Telemedicine consultation was scheduled within 72 hours of disruptive NPSs and involved a geriatrician trained in NPSs, a specialized NPS nurse representing the memory center, the LTCF physician, psychologist, general practitioner, nurses, and the patient if deemed necessary, to evaluate and formulate a plan based on best practices. 1 month later, there was a follow-up telemedicine consultation for Reassessment of the patient’s condition. Usual care was left to the auspices of each LTCF and included the possibility of referrals to suitable care options including specialized inpatient units, memory consultations, and general practitioner consultations. Participants were directed towards emergency facilities as deemed necessary.
In the current analyses (mean [SD] age, 86.8 [6.6] years; 70.2% women), DETECT participants were at least 65 years of age, with documented dementia diagnosis, social security coverage, and disruptive NPSs. Disruptive NPSs were defined as difficult to manage and/or stressful (professional or family assessment of wandering or physical aggression) requiring specialist consultation or unscheduled hospitalization.
No difference was found in hospitalizations or psychotropic drug prescriptions in the intervention group.
Telemedicine in the intervention group showed significant improvement for the neuropsychiatric inventory (NPI) frequency x severity score (P=.001), the NPI distress score (P=.03), the Activity Daily Living (ADL) Katz scale (P=.006), and several quality-of-life items vs usual care in exploratory analyses.
“Secondary analyses from DETECT study show no difference in the use of telemedicine on management of NPS in patients with dementia in LTCFs, in terms of hospitalizations and psychotropic drug prescription,” the investigators concluded, “However, some exploratory analyses indicated a positive effect of telemedicine, including severity, frequency, distress, and functional autonomy compared to usual care.”
Study limitations include underpowered sample size, study assessors not blinded to treatment allocation, the open-label nature of DETECT possibly influenced results, and the relatively short follow-up. Additionally, possible selection of positive outcome bias, no follow-up assessments by caregivers, and significant between-group statistical baseline differences in total NPI and NPI distress scores.
Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
This article originally appeared on Psychiatry Advisor
