Dementia care in DMHP.
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Transcript of Dementia care in DMHP.
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28-Sep-14 SIPSCON-2014 slide 1 of 29
A service-model for home-based care in late-stage dementia: its
scope, scale and policy implications.
(from knowledge to action)
Ramkumar G S MD(Formerly) Field Psychiatrist @ DMHP,
Kottayam.http://communitypsyindia.wordpress.com/
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How to implement what we know?
• “the science of delivery”
• “3rdrd wave of research in global health”—the newest and emerging wave that builds on the preceding biomedical 1st wave and clinical-epidemiological 2nd wave.
http://globalhealth.thelancet.com/2014/07/23/putting-collaboration-heart-applied-research-and-delivery-global-health
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Overview of presentation.
• A case example of a way to implement care for dementia in our health system.
• Why dementia? – it is a case example of a chronic illness which need a disease management approach.
• DMHP Palliative care program• Training, Task-sharing, horizontal
integration between programs, sharing and pooling of resources and manpower.
• Scope, scale and implications.
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DMHP Service pattern.• Multidisciplinary team of
Psychiatrist (or trained MO), Psychologist (MPhil), social worker (MSW), Nurse.
• Outreach clinics in CHCs or PHCs.
• Kottayam district has 16 such monthly outreach sites.
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Review of clinical data base of DMHP-Kottayam district.
• 270 of the total 725 registered are part of the clinical database.
• 12 patients were diagnosed with dementia.• Similar findings are reported from [1] DMHP
clinics from Pallakad district [2] increased utilization of DMHP clinics by elderly patients.
1. Nikhil U G, Sumesh T P, Anoop G, Shaji K S. Mental health services for older people. Indian J. Psychol. Med. 2014;36(4):449-50
2.. Tharayil HM, Thomas A, Balan B V, Shaji KS. Mental health care of older people: can the district mental health program of India make a difference? Indian J. Psychol. Med. 2013;35(4):332–4
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How to provide care for the elderly demented patient.(Scope)
• Monthly clinic based care would be inadequate.
• No provision till yet for anticholinesterase medications in DMHP drug wish list.
• Mobility of care personnel to home.• Behavioral and Psychological symptoms
(BAPD) cause maximum care taker burden. It is the commonest reason for consultation.
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Referral letter
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Overview of palliative care program
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Access to homes.
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Baseline assessment of the available human resource.
• A needs assessment survey was done among the palliative care nurses when they assembled at the district level for their monthly meeting.
• Responses from seventy nurses were received and are summarized.
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Summary findings
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Training
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To what extent is it applicable to other contexts (Scale)
• Presence of both programs through out Kerala.
• Well organised supervisory system with record keeping with direct-involvement of MO in palliative program.
• Direct involvement of local self governments and NGOs in palliative programs.
• DMHP can compliment it by horizontal interaction.
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Mental health initiatives through palliative service infrastructure.
• Mental Health Action Trust. (Mallapuram,Waynad, Kozhikode)
• Mehac Model. (Ernakulum, Alapuzha)
• IMHANS model.
Also “Critically review the existing model of DMHP”
Mental Health Interventions- From Clinic to Community and beyond: Presidential Address, SIPSCON2014, Dr CJJ.
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Policy implication• NCD- Mental health
integration.• Horizontal interaction
between vertical programs.
• Amalgamation of Centrally Sponsored Schemes.
• Provide comprehensive care at doorstep.
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• Affirmative policies cutting across program silos needed for developing such intersectional models of care.
• Pooling of resources and finances.
• Sharing of personnel in the field for task sharing
• Incentive structure for collaborative and interdisciplinary work.
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Barriers and facilitators in intersectoral linkage processes.
• Systematic, qualitative review of studies describing attempts to coordinate activities of multiple service agencies.
• System-level intersectoral linkages between the mental health and non-clinical sectors: a qualitative systemic review ; Harvey Whiteford et al, Aust N Z J Psychiatry October 2014 vol 48 no. 895-906
Facilitators
Interagency coordinating committees or intersectoral/ interface workers engaged in joint service planning.Formalised interagency collaborative agreements.A single care plan.Cross-training of staff.Service co-location.Blended funding initiatives.
Barriers
Adequacy of funding and technology.Ensuring realistic workloads.Overcoming ‘turf issues’ between service providers and disagreements regarding areas of responsibilityEnsuring integration strategies are implemented as planned.Maintaining stakeholder enthusiasm.
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Questions and comments
Don't reinvent the wheel, just realign it. Anthony J. D'Angelo