Video Transcript - Video with Rural and Remote Memory Clinic Team - Show me the Evidence (Fall 2012, Volume 1, Issue 3)

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Help Is Never Too Far Away: The Rural and Remote Memory Clinic

Saskatoon – Nipawin, 284 kms, 3hrs 16 min
Saskatoon – Birch Hills, 153 kms, 2hrs 10 min
Saskatoon – La Ronge, 383 kms, 5hrs
Saskatoon – Spiritwood, 177 kms, 2hrs 11min
Saskatoon – Loon Lake, 310 kms, 4hrs 5 min

Dr. Andrew Kirk: It's harder for people in rural areas. We're looking at a population that's often elderly who have cognitive impairment, and so it's hard to stick them in a car, drive them for four hours and then expect them to be at their best when they're being assessed. So anything we can do to minimize that travel time can help.

Dr. Margaret Crossley: Probably what is most unique about the rural and remote memory clinic is that we do focus on families, individuals and families who come from outside of urban areas. We are designed to see these families and to increase and provide services to people who typically don't access our services, and we try to provide a thorough assessment in one day.

Early diagnosis of Alzheimer's disease and related dementias is crucial.

Timely treatments can minimize symptoms.

Families and caregivers need support.

But travel demands and the need for many different specialists make it difficult for persons in rural and remote areas to get a diagnosis and then treatment.

Dr. Margaret Crossley
Associate Professor, Department of Psychology
University of Saskatchewan

There is no quick and easy blood test or other kind of investigation. It takes all information from neuroradiology to neurology, to neuropsychology, nursing, social work, preferably all of these disciplines having input and providing their perspective. Because rural and remote families are challenged to access these services which are typically in urban areas, often they're not even referred for these types of assessments.

Dr. Andrew Kirk
Head of Neurology
University of Saskatchewan

In the past, before we started doing this clinic, people might come in and see a neurologist, and then come back on another trip of a few hundred kilometres to have their CT scan done, they may need to come back for another trip to have neuropsychological assessment, and so sometimes it became quite a lengthy process just getting a diagnosis, and then of course there's follow-up after that.

At the Rural and Remote Memory Clinic, a long and difficult process is reduced to a single day.

Dr. Andrew Kirk: What happens is patients travel to Saskatoon for a one-stop shopping type of visit, so they see me, a neurologist, they see a neuropsychologist, they see a physiotherapist, they have neuroimaging, they've already had their blood work done at a preclinic visit over telehealth and we see them for one day. By the end of the day, we generally are able to give them a diagnosis based on our assessments through the day and give then a plan for follow-up, prescribe treatment where it's indicated or put them in touch with resources locally or with the Alzheimer's Society to try and improve their quality of life.

Dr. Megan O'Connell
Assistant Professor, Department of Psychology
University of Saskatchewan

Dr. Megan O'Connell: It allows them to be here just one day. It's a long day no doubt about that, but at least by the end of the day the family has a sense of, or some validation for what they've been noticing, and the person may or may not have a diagnosis and, depending on the diagnosis, may have some plans for treatment or support and follow-up.

The model makes extensive use of telehealth, beginning with a pre-interview involving patients and their families.

Dr. Megan O'Connell: Probably the most important thing about these preclinic interviews is that it allows them to get to know us a bit and get a little bit more comfortable with us. It's pretty scary, particularly if you have any awareness of early changes in your memory or other aspects of cognition or function, it's pretty scary to come in and see a specialist and potentially get the diagnosis you're quite dreading.

Telehealth is also used for follow-up and monitoring of patients and their progress.

Dr. Margaret Crossley: They [the families] come once and then we follow them quite successfully on telehealth and then we have annual briefer reviews when we invite our family members back and then maintain that contact with them. In some cases now, we've seen families for four and five years and we know that we can maintain really quite tremendous relationships with our families and provide good service using this quite novel interdisciplinary one-stop shopping approach to assessment. We just wish this model was used for other chronic health conditions because it works really so well.

Over time, this research experiment has proven to be an effective tool for delivering help to an underserved population.

Dr. Andrew Kirk: When we started doing this in 2003, no one was really doing this sort of thing. This was really the first one-stop memory clinic with telehealth follow-up in the world. And so we really didn't know that telehealth was going to work.

This is a valid way to follow patients, and I certainly encourage other clinicians to get involved with telehealth. I think this is a model that's very transplantable.