The Rural and Remote Memory Clinic (RRMC).
The clinic is located in the city of Saskatoon, in the western Canadian province of Saskatchewan.
The purpose of the original research demonstration project (2004-2009) was to increase the availability and accessibility of dementia care in rural and remote areas in Saskatchewan, to determine the acceptability of the one-stop clinic and of telehealth for pre-clinic assessments and follow-up, and to develop culturally appropriate assessment protocols for assessment of dementia in Aboriginal older adults. The focus of the clinic is on diagnosis and management of atypical and complex cases of suspected dementia. The one-stop clinic streamlines assessment and diagnosis in order to reduce repeated travel over long distances, and to shorten the time to diagnosis by coordinating an interdisciplinary assessment on one day. To be eligible for referral, individuals must live more than 100 kms from the two major tertiary centres (Saskatoon and Regina) in Saskatchewan (population approximately 1 million people, area 650,000 kms2).
The clinic model was developed with input from rural health care providers during an extensive community consultation process. The clinic addresses the challenges of access to specialist assessment, diagnosis, and management of dementia for individuals in rural and remote settings. Although current Canadian consensus guidelines suggest that most patients with dementia can be assessed and managed adequately by their primary care physicians, studies show that many general practitioners are not confident in dementia diagnosis and management. The diagnostic work-up of dementia is more difficult for rural patients, and can involve multiple specialist assessments over extended time periods. The RRMC coordinates all assessment on one day. Follow-up appointments at 6 weeks, 12 weeks, and 6 months alternate between telehealth and in-person. Annual follow-ups are conducted in-person.
International research has shown that fewer than half of all dementia cases have documented diagnoses and that diagnosis often occurs too late to be beneficial. Individuals with dementia and their caregivers who live in rural areas experience additional barriers to diagnosis. We have studied the experiences of rural family caregivers in the period leading up an assessment at the Rural and Remote Memory Clinic, many of whom reported a difficult and complex journal to achieve a diagnosis for their family member. Caregivers reported wanting to know the diagnosis so that they could move forward psychologically and make appropriate plans. This research highlighted the value that a sought-after diagnosis can bring about in the lives of caregivers and patients.
Specialized services for dementia are limited in the province of Saskatchewan. The Rural and Remote Memory Clinic is located in the city of Saskatoon, but serves rural and remote areas across Saskatchewan.
Satisfaction with the one-stop clinic day was evaluated via telephone interviews with caregivers following the clinic day assessment. The interview included the Client Satisfaction Questionnaire and open-ended questions to explore caregivers’ experiences. To evaluate telehealth vs. in-person delivery mode for pre-clinic assessment and follow-up, a single case design that alternated between telehealth and in-person appointments. Patient and caregiver satisfaction with telehealth were evaluated with the Telehealth Satisfaction Scale (TeSS) at each telehealth appointment. Rural/remote Telehealth Coordinators completed an evaluation form for each appointment, rating patient and caregiver comfort. At all follow-up appointments, patients and caregivers evaluated their overall satisfaction with the appointment and its convenience.
Patients and caregivers reported high satisfaction with the one-stop clinic model on the structured Client Satisfaction Questionnaire and open-ended questions, citing reduced travel burden, timely diagnosis, and team approach to care. Rating of satisfaction and convenience of telehealth were also high. Findings demonstrate that telehealth videoconferencing is a feasible and acceptable strategy for delivering preclinic and follow-up appointments within a rural and remote memory clinic. As a result of the positive study findings, the Saskatchewan Ministry of Health has funded the ongoing delivery of the Rural and Remote Memory Clinic since the research demonstration project ended in 2009.
More information about the research can be found in published papers by team members and on our website.
Name: Debra Morgan
Organisation: Canadian Centre for Health & Safety in Agriculture, Univeristy of Saskatchewan