App to support Community Dementia Triage
Clive Thomas, Primary Mental Health Link Practitioner
Abertawe Bro Morgannwg University Health Board
The Community Dementia Support Teams in ABMU are using an electronic app called CANTAB Mobile to help triage for clinically significant memory impairment.
The team are using this to expedite appropriate referrals to the Memory Assessment Service by ‘screening in’ only those with a clinically significant memory impairment. This is helping to tackle the issue of poor dementia diagnostic rates by encouraging GPs to identify those patients who are at risk and who they think would benefit from more in-depth cognitive assessment. This represents a significant saving and more efficient use of current resources.
PLANNING & DEVELOPMENT:
The project is delivered through The Bevan Commission’s Health Technology Exemplar Programme and its partners in industry, Cambridge Cognition. This collaboration has enabled the purchase of multiple use licenses for use by Dementia Support Workers who can now deliver a robust method of triage for clinically significant memory impairment in the patient’s own home. This ensures faster signposting to the appropriate pathway and further supports the Welsh Government initiative to employ Dementia Support Workers within Primary Care to help improve dementia diagnosis.
The CANTAB Mobile is an effective test of cognition and is 100% sensitive and 92% specific in detecting Alzheimer’s disease (AD). It uses Paired Associates learning to detect changes to memory and uses a touch-screen i-Pad to show a sequence of abstract shapes.
Unlike other paper-based cognitive tests there is no reliance on fine motor skills to draw or write. Although not diagnostic, the results are easy to interpret and using a traffic light system (in which RED means clinically significant impairment) it is useful in helping to broach the subject of dementia with both the family and GP alike.
The test highlights the need for further in-depth cognitive testing and is suitable for administering by both qualified and unqualified staff.
The voiceover instructions are available in multiple languages, including Welsh, making it highly accessible to all patients.
BENEFIT & IMPACT:
Access to a robust method of triage is essential and the CANTAB Mobile test means that GPs can now action referrals to Specialist Memory Services with confidence. Not only does this screen out unnecessary referrals and reduce the burden on existing resources but has also helped to explore new pathways to diagnosis.
By foremost raising awareness of the need to diagnose dementia, patients can then be signposted for appropriate help. In ABMU, the CANTAB has been very successful in triaging for clinically significant memory impairment and is recommended as a suitable precursor for all referrals to Memory Assessment Services throughout Wales.
FIT WITH PRUDENT HEALTH:
The CANTAB rapidly establishes whether memory impairment is clinically significant or not and highlights the need to diagnose dementia. It identifies early those patients who need a referral for more in-depth cognitive testing whilst also identifying those patients that don’t. Included within the test is the Geriatric Depression Scale and Activities of Daily Living, which can also help signpost patients for treatment other than dementia where indicated. This represents significant progress in terms of more efficient use of resources in line with the principles of Prudent Healthcare.
Part of cohort Bevan Exemplar Projects 2016-17