Geriatric outpatients with memory-related issues will now receive more streamlined care thanks to the development of an Integrated Care Pathway (ICP) for the CAMH Memory Clinic.
(L to R) Joydip Banerjee, Manager, Geriatric Mental Health Outpatient Clinics, Dr. Sanjeev Kumar, Geriatric Psychiatrist & lead psychiatrist, Memory ICP project, Dr. Petal Abdool, Medical Head, Geriatric Outpatient Clinic.
Dr. Sanjeev Kumar, lead physician on the CAMH Memory Integrated Care Pathway (ICP) project, says this new ICP will allow clinicians from multiple disciplines to map out a treatment plan from start to finish. “It will help standardize care for clients with memory disorders in a more evidence-based manner, improving client care and outcomes.”
“This ICP is one of the best ways of treating memory patients in the province,” says Joydip Banerjee, Manager, Geriatric Mental Health Outpatient Clinics at CAMH.
“Our clients get to work with an inter-professional care team that includes physicians, nurse practitioners, nurses, occupational therapists and social workers who give advice and recommend both medication and non-medication treatments. For example, a nurse practitioner does an initial assessment and flags any medical issues for the psychiatrist that may be contributing to their memory concern. The Occupational Therapist can help with functional issues related to mobility and cognitive deficits.
Social workers like Esther Yoo-Parlan are there to provide clients and their families with links to community resources. “Dementia is a progressive disorder. Our role is to follow a client as their illness progresses. It is important that a team of allied health professionals work together to follow the client through their journey.”
“Memory disorders and related mood, personality and functional changes are not illnesses that one doctor can harness,” adds Dr. Petal Abdool, Medical Head of Geriatric Outpatient Clinic. “You need the help of an interdisciplinary team. They all have to be on the same page to understand the complex needs of this population.”
Improving Access to Clinical Services
Dr. Tarek Rajji is the Chief of Geriatric Psychiatry at CAMH. He says the memory ICP will improve access to patients and families waiting for a memory assessment because of its systematic approach to assessment, referrals, and interventions, including referrals to clinical research.
“In the past few years, the number of new clients assessed in the memory clinic has increased by 500 percent. We can now see clients within less than two weeks.”
This new ICP will also help meet the Memory Clinic’s recruitment targets for large trials like the PACt-MD (Prevention of Alzheimer’s Dementia with Cognitive Remediation plus Transcranial Direct Current Stimulation in Mild Cognitive Impairment and Depression) study funded by Brain Canada, the largest ever grant funded in Canada to prevent Alzheimer’s dementia.
“We designed the Memory Clinic ICP with integration of clinical research and clinical services at the front of our mind. We have big demands from the research end and we need to improve access to our clinical services. This new ICP will accommodate these demands of research with the capacity of the clinic,” says Dr. Rajji.
Patient Centered Care
Rita Desai, Project Manager, Integrated Care Pathways Program, calls the Memory ICP “an excellent example of a patient-centered initiative that will provide state-of-the-art integrated care to the patients with Dementia in an outpatient setting.
“The design of the pathway was created using the unique perspectives from a multi-disciplinary team and subject matter experts to blend best practices and evidence, while maintaining the focus on patient centeredness.”