Facility policies impeding access to online dementia advice

A lack of access to the internet or smart devices in aged care facilities is hindering clinician access to evidence-based information on managing dementia-related behaviours, according to an evaluation of the BPSD Guide App.

The app is based on the Behaviour Management, A Guide to Good Practice, Managing Behavioural and Psychological Symptoms of Dementia (BPSD) and was developed by the Dementia Collaborative Research Centre for Assessment and Better Care (DCRC ABC).

The guides support clinicians caring for people with dementia who present with BPSD in residential and community aged care.

An evaluation based on interviews with 61 clinicians working in dementia behaviour management found it to be an effective tool, however, only having access to “brick” phones in the workplace, a lack of internet access and policies in residential aged care facilities that prohibited the use of smartphones, were among barriers reported.

DCRC ABC director Professor Henry Brodaty said the feedback highlighted that clinicians liked the app and found it useful but some could access the app in the workplace.

“People working in nursing homes are not permitted to bring in devices to use and have mobile phones with them. In modern day, that needs to change,” Professor Brodaty told Technology Review at the National Dementia Research and Knowledge Translation Forum, where the evaluation was presented.

Professor Brodaty said  a high number of people reported these barriers, with nurses working in aged care facilities the most affected.

‘Bring your own device’ on providers’ agendas

Leading Age Services Australia (LASA) CEO Patrick Reid said aged services was fast catching up when it came to technology but still there were risks to be mitigated when encouraging personal devices for work purposes.

“Breaches of privacy legislation and inappropriate data retention would be some of the primary concerns, which apply to anyone working directly with people and where personal and sensitive information may be at hand,” Mr Reid told Technology Review.

Other issues organisations needed to consider included whether staff may be disadvantaged if they could not afford the latest device and how to monitor and manage data usage with often limited IT resources, he said.

However, there was growing evidence around the risk assessment and implementation of staff using their own devices in a healthcare setting and some LASA members were looking at how they could support staff to use decision support, real-time data or analysis apps, Mr Reid said.

“We have a number of providers who have moved to policies allowing staff to use personal devices at work through a planned risk assessment, with a focus on improving outcomes for staff and clients. Some have limited the range of approved devices to minimise IT support issues or have provided security protocols and software to enable both security and hacking/virus prevention.”

He said future apps or systems would increasingly support clinicians and care staff in their roles and it was important any such apps drew on the latest medical information and were approved for use.

“Ensuring quality in the information provided through apps will be one of the most important factors for organisations to consider when reviewing their own policies and processes, and by our regulatory and peak bodies at a national level,” Mr Reid said.

Fast facts: App user data

The evaluation also utilised inbuilt Google Analytics features to analyse user data from December 2014 to 31 July 2015. Among the findings:

• 4,016 app users and 8,521 sessions during the review period
• most users were from the United States (1,281) followed by Australia (923)
• most sessions occurred in Australia (3,836) followed the US (1,496)
• Victoria (266), New South Wales (264) and South Australia (107) had the highest number of app users
• the highest number of sessions occurred in NSW (1,299)
• a quarter of users were returning users
• aggression was the most accessed BPSD (3,796) followed by disinhibited behaviours (2,235), psychotic symptoms (1,854), agitation (1,678), wandering (1,508), vocally disruptive behaviours (1,332), nocturnal disruption (1,261), anxiety (895), depression (644) and apathy (407)
• the clinical scenario in Aggression was the screen viewed for the longest time period (1:21 mins)
• more users accessed the app on a smartphone device than a tablet device with Apple proving more popular than Android in both categories
• of the 1,435 users who completed the demographic survey, 38 per cent worked in residential aged care and 24 per cent in community care
• the most common role or professional background was registered nurse or practice nurse (20 per cent) followed by allied health professional (14 per cent), facility or community manager (8 per cent) and assistant in nursing/personal care assistant (8 percent)
• 5 per cent of users were family carers and only a small number were Aboriginal and/or Torres Strait Islander health workers or bilingual/bicultural/CALD health workers.

Fast facts: Clinician feedback data

Uses of the App

• Reinforce clinical knowledge
• Capacity building and education
• Information tool
• Validate clinician advice
• Case management

Useful aspects

• Accessibility and mobility
• Alternative to the large BPSD Guide book
• Clear evidence for interventions
• Clinical scenarios as evidence-based examples
• Search bar for locating information quickly
• Similar structure to BPSD Guide book

Barriers to use

• Lack of access to devices in the workplace
• Limited experience using technology
• Level of app content not comprehensive enough
• Evidence does not always support clinical advice
• Inappropriate to use in front of the person with dementia

The evaluation informed the development of a modified version the app targeting family and non-tertiary qualified carers called Care4Dementia, which was launched at the forum.

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