Remote primary care consultations for people living with dementia during the COVID-19 pandemic: experiences of people living with dementia and their carers

Abstract

Background: COVID-19 has accelerated remote healthcare provision in primary care, with changes potentially permanent. The implementation of remote provision of healthcare needs to hear from vulnerable populations, such as people living with dementia. Aim: To understand the remote healthcare experiences of patients living with dementia and their family carers during the COVID-19 pandemic. Design and setting: Qualitative interviews with community-based patients living with dementia and their carers during early months (May-August 2020) of the COVID-19 pandemic in England. Methods: Semi-structured interviews were conducted remotely by telephone or video call with 30 patients living with dementia and 31 carers. Data were analysed using thematic analysis. Results: Three main themes were derived relating to: 1) proactive care at the onset of COVID-19 restrictions, 2) avoidance of healthcare settings and services, and 3) difficulties with remote healthcare encounters. People living with dementia and their carers felt check-up calls were reassuring but limited in scope and content. Some avoided healthcare services, wishing to minimise COVID-19 risk, reduce NHS burden, or encountering technological barriers. Difficulties in remote consultations included lack of prompts to remember problems, dealing with new emerging problems, rescheduling/missed calls, and inclusion of the person with dementia’s voice. Conclusion: While remote consultations could be effective, pro-active calls could be more structured around needs, and consideration should be given to replace non-verbal prompts to describe problems, particularly for new health concerns. In continuing remote consultations, it is important to facilitate engagement with patients living with dementia and their carers to ensure best practice.

Remote by default general practice: must we, should we, dare we?

“…[9][10][11][12] A recent qualitative study of the patient and carer experience of check-up calls for dementia during the pandemic suggested a somewhat transactional character and poor match to needs. 13 On the other hand, remote consulting has obvious benefits in rural and remote settings, and for clinicians who are shielding, in quarantine, or have caring responsibilities. And they are popular with some -though not all -patient groups.…”

Dementia wellbeing and COVID‐19: Review and expert consensus on current research and knowledge gaps

“…Teleconsultation used in memory clinics during lockdown 80 , 81 , 87 was helpful for some carers, but others were uncertain about their purpose and usefulness 5 . An adapted UK study (PriDem) found that many people living with dementia and their family carers were avoiding contact with primary health services and had mixed opinions of the value of telephone contact from primary care 88 …”

Impact of COVID-19 on ‘living well’ with mild-to-moderate dementia in the community: findings from the IDEAL cohort

“…This reflected indications gathered in the early stages of the pandemic [27,28], and was observed despite perceptions that healthcare needs were affected by the pandemic and reports of developing new health problems. The lack of reports of any negative impact was reassuring given early concerns that negative consequences for physical health might not be detectable immediately but might become evident over a longer time-period [48]. One factor that possibly mitigated against a negative impact on physical health in our sample was the availability of GP telephone consultations and an increase in the proportion having a named health professional as a key point of contact.…”