CAMH follows the following definition of an Integrated Care Pathway (ICP) as defined by Middleton S Barnett J & Reeves D (2001): a Clinical Pathway with multidisciplinary outline of anticipated care, placed in an appropriate time frame. ICPs are popular in medical procedures such as cardiac and cancer around the globe. However, the use of ICP for Mental Health is more common in Europe and a few other parts of the world, but is uncommon in North America. In the past 3 years CAMH has successfully setup an Integrated Care Pathway (ICP) program and developed and implemented 7 ICPs for specific conditions and patient groups including the first related to the diagnosis of ‘Dementia – Agitation and Aggression’.
The core principles of ICPs at CAMH (adopted from Alberta Health Services) are to identify What to do, When to do it, Who will do it, How to do it and Where will it be done. The key enablers of ICP includes: evidence informed practice, improving efficiency in processes, building effectiveness in teams, improving inter-professional collaboration, outcome oriented design, ongoing evaluation of key components of ICP, and building sustainability. All this is done with a key focus on improving patient centered care, finding variance in service delivery and standardizing these to enhance services and ongoing improvement. The ICP planning and implementation is done using methods such as Project Management, Change Management, Knowledge Translation, LEAN methodologies and Implementation Science.
Alzheimer’s dementia (AD) and related neurodegenerative diseases are inflicting a national crisis. The number of Canadians living with cognitive impairment, including dementia, is about 747,000. This number will double by 2031. Aggression and agitation are highly prevalent among patients with AD. They impose a tremendous burden on the individuals living with AD, their families, caregivers, and the health care systems beyond the cognitive impairment per se. They are the leading cause for hospitalizing patients with AD and transferring them into long-term care facilities.
To address the above deficiencies, in 2013 CAMH developed and implemented an ICP related to the diagnosis of ‘Dementia – Agitation and Aggression’. Clients with this diagnosis receive a clear direction on their pharmacological and non-pharmacological interventions during their inpatient stay. This ICP is conducted in the Geriatric Mental Health Services (GMHS) unit of the Underserved Populations Program which accepts referrals of clients 65 years of age and older.