Providing Mental Health Assessments and Follow Up For Seniors

Objectives

• Increase timely access to appropriate care
• Reduce avoidable emergency department visits

Model

Referrals to this program are accepted from physicians (general practitioners and specialists), health professionals/community agencies and through self-referral with general practitioners’ support. Once referred, patients proceed into an intake and triage phase, where an IPOP team clinician is assigned to complete a psychogeriatric assessment in the patient’s home. Assessment findings guide follow up care that may include a recommendation for a virtual visit with the IPOP psychiatrist.

Prior to the geriatric psychiatric assessment, an assessment report is sent to the physician for review. A virtual visit date and time is set, and the clinician is present at the client’s location to set up the virtual visit equipment and ensures the patient is ready for the visit.

During the virtual assessment, the IPOP psychiatrist does a complete psychosocial assessment and treatment plan, which is then reviewed by both the IPOP team and the patient’s primary care physician.

Technology Type:
IPOP team accesses OTN’s secure provincial videoconferencing platform, available through the OTNhub, to connect patients to their provider for a video visit through Personal Computer Video Conferencing (PCVC)platform.

Outcomes

The wait list for an in clinic face to face visit with a geriatric psychiatrist within a hospital setting is 8-10 months, but through the IPOP this wait time is reduced to only 6-8 weeks.

From a Client Satisfaction/Experience Survey:

• “Having the appointment with the geriatric psychiatrist completed via technology at our home was the most helpful aspect of your services. As my husband refuses to go outside, this was the only way this would have been possible. Thank you.”
• “The ability to have the appointment provided by using OTN made it a very comfortable environment.”
• “It was great to have all the services, especially the appointment with the psychiatrist, performed in my home. All appointments ran on time and very smoothly.”
• One client (aged 93) stated that “she never thought she would live to see the day that she would be having a doctor’s appointment through a computer.”

Of the 27 surveys received to date 97% agreed that they felt comfortable with the use of virtual video visit.

Change Required to Support the Model

The Integrated Psychogeriatric Outreach Program (IPOP) provides aa interprofessional team of community clinicians comprised of a Nurse Practitioner, Registered Nurse, Social Worker and an Occupational Therapist. Supporting care via video visits was new to the team and additional training and practice was required to increase their confidence to provide virtual care. Virtual visits were established as a component of the IPOP care model when the program was launched in April 2019. This made adoption easier as virtual visit were not added to the program as a change from past practice.

Two geriatric psychiatrists, one from UHN and one from MSH support the model and have capacity to see 14 patients/month via OTN. As home visits were not part of the budget, the physicians recruited for the program were on board to incorporate virtual visits into the service delivery model. Each physician has dedicated time in their schedules to provide video visits for IPOP clients.

Adoption Rate

Since this program was started in April of 2019, there have been over 62 geriatric psychiatry OTN visits.

• The Markham GP has capacity to complete 8 visits per month
• The UHN GP has capacity to complete 4 visits per month

Disclaimer

OTN is an independent, not-for-profit organization funded by the Government of Ontario. The views expressed here are the views of OTN, or the respective authors if a third-party, and do not necessarily reflect those of the Province. For further information, please note the Proprietary Rights detailed within the OTN Terms of Service available at https://otn.ca/terms-conditions/