Transforming geriatric care with virtual tools

The family of one of Dr. Samir K. Sinha’s patients decided it was too physically and mentally challenging to bring her to his geriatric clinic, given her advanced level of dementia.  

The most vulnerable patients – often the frail elderly – are home bound. The medical specialists they need are hospital-bound. Complicating matters, these patients may be dealing with a mix of conditions and issues – cognitive, social and/or mobility deficits and, often, more than one chronic condition. They need assessment and a treatment plan from more than one kind of specialist and sometimes the primary care provider isn’t sure who to ask for help from first. 

Dr Sinha, the Director of Geriatrics at Sinai Health System and the University Health Network feels that virtual care may be especially transformational in geriatrics. It brings convenience, connectedness and integration that, when properly leveraged, helps solve problems for patients, their families and providers.

For this patient, Dr. Sinha used the Telemedicine Impact Plus (TIP) Clinic program – where he is clinical lead for the geriatric services arm. TIP brings together geriatric and psychiatry specialists, primary care providers, patients and their families in a 90-minute virtual case conference that results in a comprehensive treatment plan that reflects patient needs and wants.

“Ninety-five per cent of primary care physicians are satisfied with the recommendations offered during the TIP case conference,” Dr. Sinha says. “And 92 per cent of patients and their caregivers feel confident that their chronic care will be better managed as a result of our TIP Clinics.” 

How the Telemedicine Impact Plus (TIP) Clinic program works

A telemedicine Clinical Nurse Specialist (CNS) completes a comprehensive geriatric patient assessment - most patients are referred by their primary care provider – and then chooses the right TIP Clinic team to best meet patient needs. The Geriatrics TIP Clinic team typically includes Dr. Sinha; Dr. Sarah Colman, a geriatric psychiatrist at CAMH; a specialist home and community care coordinator; a community pharmacist and a behavioural support specialist, and other specialized care providers.   

The team meets by video through the Ontario Telemedicine Network (OTN) to review the assessment. A group case conference, which includes the patient, family and primary care provider, follows. 

The patient and family are interviewed and then there’s a break for a 10-minute case conference among the assembled professionals, and to give the patient and care partners time to reflect and see if they have further questions.  

Once a proposed plan is formulated, everyone reconnects by video to explain, modify and come to a mutual agreement on a treatment plan. Follow-up, including additional video consultations when necessary, is conducted by the CNS.

The Telemedicine Impact Plus (TIP) Clinic program is funded by the Toronto Central Local Health Integration Network (LHIN) and delivered by a Sinai Health System and Centre for Addiction and Mental Health (CAMH) partnership.    

Read about the caregiver’s experience.