MONTREAL – Due to its aging population, Quebec will need to care for an increasing number of seniors in the coming years. In order to be able to treat these patients better, a pilot project will be launched in the health network this fall to build bridges between geriatricians and the first line.

The Responsible Geriatrician project is led by the Department of Health and Human Services (MSSS) in partnership with the Association of Geriatric Physicians of Quebec (AMGQ). The initiative also received more than $4.5 million in financial support from the Institute for the Appropriateness of Medical Acts (IPAM) fund to set up the pilot and roll it out across the network.

In fact, not one but four parallel pilot projects will be launched in each of the University Networks for Health and Social Services (RUISSS), ie those associated with Université Laval, McGill University, the University of Montreal and the University of Sherbrooke.

The pilot version is scheduled to run from September 2023 to March 2024, the time to properly implement the practice and make the necessary improvements along the way. Subsequently, the MSSS is moving forward with the ambitious timeline to deliver a real network-wide program by the end of 2024.

Put simply, this approach can be described as a way of bringing geriatricians, a tertiary specialty, closer to the frontline. Specifically, general practitioners, specialized nurses or home care teams can forward complex patient cases to an geriatric specialist.

Dyane Benoit, responsible for the implementation of the project as part of the general management of the services for the elderly and caregivers of the MSSS, indicates that the main objective is to improve access to geriatric expertise. At the same time, we also strive to improve the geriatric competence of first responders through training courses for geriatricians.

This approach is at Dr. David Lussier, geriatrician at the Institut universitaire de gériatrie de Montréal, very popular, who says: “Geriatrics really needs to get out of the hospitals and be able to go to the patient, to the front lines, on the ground”.

From his experience, Dr. Lussier reports that many primary care physicians submit referrals for cases of cognitive impairment with mental behavioral symptoms of dementia (BPSD). We are talking about patients who may be restless or aggressive.

He believes that geriatricians could also be consulted to confirm diagnoses of cognitive pathologies related to fall problems or to offer their opinion in a disability mandate case.

To ensure the effectiveness of the project, a navigator is responsible for analyzing each individual request before it is forwarded to the on-call geriatrician. This intermediary must ensure that all options have been explored before seeing the geriatrician. He will also be responsible for preparing files and coordinating counseling plans for optimal performance.

“We don’t want a consultation six months later,” stresses Ms. Benoit. We would like immediate advice.” She adds that there is a lack of organized accessibility and the program fills that need.

The agreement between the Ministry and AMGQ stipulates that a geriatrician will be available for these consultations from Monday to Friday, from 8 a.m. to 5 p.m.

prevention

This program to promote access to geriatricians is also intended as a prevention tool, aimed at prolonging the home care of the elderly and avoiding as much as possible the deterioration of their physical and mental condition.

“It’s an interesting path,” recognizes Dyane Benoit, citing possible interventions at home, but also in intermediate resources or in private homes for the elderly. We would like the person who is at home to arrive at the CHSLD as late as possible. And even with a CHSLD, the person is entitled to this expertise in order to be the best possible in their living environment.

dr David Lussier agrees that prompt intervention in the patient’s home or APR, in particular, could prevent loss of autonomy.

“What we can prevent above all are visits to the emergency room. When we have a really complex patient and we don’t know what to do with them, the geriatrician can help and avoid a visit to the emergency room. It would be a really positive effect.”

According to the MSSS, there are approximately 110 geriatricians in the Quebec network, which is insufficient to meet all needs in each region.

The Center of Excellence in Aging of Quebec is also contributing its expertise to the project. He will conduct an implementation assessment to make adjustments along the way, to fix what’s not working, and to expedite deployment.

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