P129: Buiding a telepsychiatry program for older people in rural Portugal

Abstract

The geriatric psychiatry team at the Local Health Unit of Baixo Alentejo (ULSBA) serves the largest district of Portugal, the district of Beja, covering 10,4% of Portugal area. Baixo Alentejo is predominantly rural and a relatively poor area, with a high percentage of older adults (28% of its population being over 65 years old), a declining population due to unremitting exodus, an underdeveloped public transportation system and insufficient health care assistance. Among the telemedicine programs developed in the last decades, care in nursing homes for the elderly has figured prominently. Many studies report decrease of costs and inconvenience resulting from patients having to travel to hospitals, and so to optimize, simplify and reduce costs of psychogeriatric care.

We report the planning and implementation of a telepsychiatry program adopted by a geriatric psychiatry team of a local mental health service, starting in 2023. Videoconference consultations were provided for 58 nursing homes, with an average of 10 patients per day. Most patients were initially evaluated at the hospital by a nurse and a psychiatrist, being all subsequent consultations made every three to six months. Most patients were female. The most frequent diagnosis was dementia due to Azheimer disease. A clinical evaluation standardized sheet was sent prior to the consultation and the interview with the nurse had the purpose of completing those data that the psychiatrist considered necessary after reading the material sent. The presence of staff in the room with the patient not only helped carry out the interview, but it also allowed observation of how the patient interacted in a face-to-face situation.

Healthcare institutions all over the world are increasingly adopting telehealth services given their numerous benefits in enhancing access to care. This practice comes with several challenges, being the fact that a nurse or someone from the staff must be present in the teleconsultation one of the most significant ones, as staff is already overburdened.Innovations to overcome sensory deficits and collaboration with community services should be explored to improve its acceptance among the most vulnerable population.It is fundamental to assess cost-effectiveness and patient/caregivers satisfaction with the service.