Quebec pilot project will put geriatricians on the front line to improve care for seniors

Palmiro Tami, 82, holds hand with his wife Franca Persico as the have a walk in the garden of the Fondazione Martino Zanchi nursing home, after receiving the second shot of Moderna COVID-19 Vaccine, in Alzano Lombardo, northern Italy, Monday, March 22, 2021. (AP Photo/Luca Bruno) Quebec is starting a pilot project putting geriatricians on the front line to offer better care to seniors.

With its aging demographics, Quebec will have to care for more and more seniors in the coming years. In order to better treat these patients, a pilot project will be implemented this fall in the healthcare network to build bridges between geriatricians and front-line physicians.

The "responding geriatrician" project is led by the Ministère de la Santé et des Services sociaux (MSSS) in collaboration with the Association des médecins gériatres du Québec (AMGQ). The initiative has also received financial support of over $4.5 million from the Institut de la pertinence des actes médicaux (IPAM) fund, to set up the pilot project and roll it out across the network.

In fact, not one, but four parallel pilot projects will be launched in each of the university health and social services networks (RUISSS), i.e. in establishments associated with Université Laval, McGill University, Université de Montréal and Université de Sherbrooke.

The pilot version is scheduled to run from September 2023 to March 2024, to allow time for the practice to be fully implemented and for any necessary improvements to be made along the way. The MSSS then has an ambitious timetable to roll out a full-fledged program throughout the network by the end of 2024.

In simple terms, the approach can be described as a way of bringing geriatric physicians, a tertiary specialty, closer to the front line. In concrete terms, family doctors, specialized nurse practitioners or homecare teams will be able to refer complex patient cases to an aging specialist.

Dyane Benoit, who is responsible for setting up the project within the MSSS's Services to the Elderly and Caregivers Branch, explains that the main objective is to improve access to geriatric expertise. At the same time, they're looking to enhance the geriatric expertise of front-line workers through training with geriatric physicians.

This approach appeals to Dr. David Lussier, a geriatrician at the Institut universitaire de gériatrie de Montréal, who believes that "geriatrics really needs to get out of the hospitals and closer towards the patient, on the front line, in the field."

Based on his experience, Dr. Lussier expects that many family doctors will submit consultation requests for cases of cognitive impairment with psychological behavioural symptoms of dementia (BPSD). Specifically, patients who may be agitated or aggressive.

He believes that geriatricians could also be called in to confirm diagnoses of cognitive pathologies linked to problems with falls, or to give their opinion in the context of an incapacity mandate.

To ensure the project's effectiveness, a key player will be responsible for analyzing each request before submitting it to the "on-call" geriatrician. This intermediary will ensure that all options have been considered before calling in the geriatrician. He or she will also be responsible for preparing files and coordinating consultation schedules for optimum efficiency.

"We don't want a consultation six months later," Benoit said. "We want an immediate consultation." She added that what's missing is organized accessibility, and that's the need the program is expected to address.

The agreement between the Ministry and the AMGQ provides for a geriatrician to be available for these consultations from Monday to Friday, 8 am to 5 pm.

PREVENTION

At the same time, this program to promote access to geriatricians is intended as a preventive tool to help seniors stay in their own homes as long as possible and avoid any deterioration in their physical and mental state.

It's an interesting avenue," admits Benoit, citing possible interventions at home, but also in intermediate resources or private seniors' residences. We want people at home to move to a CHSLD as late as possible. And even in CHSLD, the person is entitled to this expertise to be as well as possible in their living environment."

Lussier agrees that early intervention with the patient at home or in an RPA could, in particular, prevent loss of autonomy.

"What we can prevent, above all, are emergency room visits. If you have a really complex patient and you don't know what to do with him, the geriatrician could help and avoid an emergency visit. That would be a really beneficial effect."

According to MSSS data, there are around 110 geriatricians in the Quebec network, which is not enough to meet all the needs of each region.

Quebec City's centre for excellence in aging is also contributing its expertise to the project. It will evaluate the rollout of the new project to suggest adjustments along the way to correct what's not working and speed up deployment.

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This report was first published in French by The Canadian Press on July 29, 2023.