Psychological telephone triage system for outpatient memory clinics - a way for adaptation to new challenges of increasing dementia prevalence and new treatment options?

Abstract

Background: The increasing prevalence of dementia and new therapeutic developments for Alzheimer's disease (AD) have created an urgent need for rapid and cost-effective methods to diagnose those affected in the early stages of the disease. Unlike emergency departments, memory clinics lack triage systems, e.g. the Manchester Triage System.

Method: This retrospective, observational study evaluated the effects of a psychological telephone triage (PTT) system for people requesting an initial assessment at a specialized outpatient memory clinic over a 15-months period in terms of waiting times, staff resources, and as a screening method for cognitive disorders. The PTT consisted of an interdisciplinary pre-screening of available preliminary patient information prior to telephone contact, a semi-structured interview of approximately 30 min with a clinical psychologist, and telephone psychological counseling if there was no indication for an on-site dementia assessment. Based on the PTT interview, patients were triaged using a 4-level priority system (red = acute, yellow = subacute, green = not acute, blue = no indication/counseling). The results were compared with data from the two years prior to the introduction of PTT.

Results: The data of 612 people (327 before and 285 after the introduction of PTT) who called the secretary's office between January 1, 2021 and April 30, 2024 and requested an initial assessment were analyzed. Of the original sample who called after the introduction of PTT, 66.7% had an indication for an on-site visit and were invited to do so. This was accepted by 51.6%. A further 14% received psychological telephone counseling, resulting in a 34% reduction in on-site visits. Patients triaged as acute cases had the shortest waiting time and presented with the most severe cognitive and functional symptoms at the on-site visit.

Discussion: Our study shows that PTT is an effective method to identify patients with urgent need for an initial dementia assessment and to provide psychological counseling as an alternative to on-site visits. We expect that this will reduce the number of emergency admissions and thus the burden on caregivers and the healthcare system. This PTT concept can thus help to better manage the increasing need for initial assessments in the context of new therapies for AD and the increasing prevalence of dementia in general.