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Campbell-Enns HJ, Bornstein S, Hutchings VMM, Janzen M, Kampen M, O'Brien K, Rieger KL, Stewart T, Zendel BR, Doupe MB. The experiences and needs of unpaid family caregivers for persons living with dementia in rural settings: A qualitative systematic review. PLoS One 2023; 18:e0286548. [PMID: 37315078 DOI: 10.1371/journal.pone.0286548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023] Open
Abstract
PURPOSE Unpaid family caregivers provide extensive support for community-dwelling persons living with dementia, impacting family caregivers' health and wellbeing. Further, unpaid family caregiving in rural settings has additional challenges because of lower access to services. This systematic review examines qualitative evidence to summarize the experiences and needs of rural unpaid family caregivers of persons living with dementia. METHODS CINAHL, SCOPUS, EMBASE, Web of Science, PsychINFO, ProQuest, and Medline were searched for articles investigating the experience and needs of rural family caregivers of persons living with dementia. Eligibility criteria were: 1) original qualitative research; 2) written in the English language; 3) focused on the perspectives of caregivers of community-dwelling persons with dementia; 4) focused on rural settings. Study findings were extracted from each article and a meta-aggregate process was used to synthesize the findings. FINDINGS Of the 510 articles screened, 36 studies were included in this review. Studies were of moderate to high quality and produced 245 findings that were analyzed to produce three synthesized findings: 1) the challenge of dementia care; 2) rural limitations; 3) rural opportunities. CONCLUSIONS Rurality is perceived as a limitation for family caregivers in relation to the scope of services provided but can be perceived as a benefit when caregivers experience trustworthy and helpful social networks in rural settings. Implications for practice include establishing and empowering community groups to partner in the provision of care. Further research must be conducted to better understand the strengths and limitations of rurality on caregiving.
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Affiliation(s)
| | - Stephen Bornstein
- Department of Political Science, Memorial University, St. John's, Newfoundland, Canada
- Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Veronica M M Hutchings
- Aging Research Centre-NL, Grenfell Campus, Memorial University, Corner Brook, Newfoundland and Labrador, St. John's, Canada
| | - Maya Janzen
- School of Public Policy and Administration, Carleton University, Ottawa, Ontario, Canada
| | - Melanie Kampen
- Centre for Transnational Mennonite Studies, University of Winnipeg, Winnipeg, Manitoba, Canada
| | - Kelli O'Brien
- St. Joseph's Care Group, Thunder Bay, Ontario, Canada
- Western Health, Corner Brook, Newfoundland and Labrador, Canada
| | - Kendra L Rieger
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
| | - Tara Stewart
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Benjamin Rich Zendel
- Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
- Aging Research Centre-NL, Grenfell Campus, Memorial University, Corner Brook, Newfoundland and Labrador, St. John's, Canada
| | - Malcolm B Doupe
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Kovaleva MA, Kleinpell R, Dietrich MS, Jones AC, Boon JT, Duggan MC, Dennis BM, Lauderdale J, Maxwell CA. Caregivers’ experience with Tele-Savvy Caregiver Program post-hospitalization. Geriatr Nurs 2023; 51:156-166. [PMID: 36990041 DOI: 10.1016/j.gerinurse.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/30/2023]
Abstract
Despite the frequent hospitalizations and readmissions of persons living with dementia (PLWD), no telehealth transitional care interventions focus on PLWDs' unpaid caregivers. Tele-Savvy Caregiver Program is a 43-day evidence-based online psychoeducational intervention for PLWDs' caregivers. The aim of this formative evaluation was to explore caregivers' acceptability of and experience with their participation in Tele-Savvy after their PLWDs' hospital discharge. Additionally, we gathered caregivers' feedback on the recommended features of a transitional care intervention, suitable for caregivers' schedule and needs post-discharge. Fifteen caregivers completed the interviews. Data were analyzed via conventional content analysis. Four categories were identified: (1) Tele-Savvy improved participants' understanding of dementia and caregiving; (2) hospitalization started a "new level of normal"; (3) PLWDs' health concerns; and (4) transitional care intervention development. Participation in Tele-Savvy was acceptable for most caregivers. Participants' feedback provides content and structural guidance for the development of a new transitional care intervention for PLWDs' caregivers.
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Affiliation(s)
- Mariya A Kovaleva
- College of Nursing - Omaha Division, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, USA.
| | - Ruth Kleinpell
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA; Department of Biostatistics, Vanderbilt University School of Medicine, 1161 21st Ave S, #D3300, Nashville, TN 37232, USA
| | - Abigail C Jones
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA; Yale University School of Nursing, 400 West Campus Drive, Orange, CT 06477, USA
| | - Jeffrey T Boon
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA; Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Maria C Duggan
- Division of Geriatric Medicine, Vanderbilt University School of Medicine, 1161 21st Ave S, #D3300, Nashville, TN 37232, USA; Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System, 1310 24th Ave South, Nashville, TN 37212-2637, USA
| | - Bradley M Dennis
- Division of Acute Care Surgery, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Jana Lauderdale
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA
| | - Cathy A Maxwell
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA
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Franco BB, Boscart VM, Elliott J, Dupuis S, Loiselle L, Lee L, Heckman GA. "I Hope That the People Caring for Me Know About Me": Exploring Person-Centred Care and the Quality of Dementia Care. Can Geriatr J 2022; 25:336-346. [PMID: 36505910 PMCID: PMC9684023 DOI: 10.5770/cgj.25.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Person-centred care is at the core of high-quality dementia care but people living with dementia are often excluded from quality improvement efforts. We sought to explore person-centred care and quality of care from the perspectives of persons living with dementia in the community and their care partners. Methods We used a qualitative descriptive approach with in-person, semi-structured interviews with 17 participants (9 persons living with dementia and 8 care partners) from Ontario, Canada. Results Participants report that person-centred care is essential to the quality of dementia care. Three themes were identified that describe connections between person-centred care and quality of care: 1) "I hope that the people looking after me know about me", 2) "I just like to understand [what's happening] as we go down the road", and 3) "But the doctor doesn't even know all the resources that are available." Participants perceived that quality indicators over-emphasized technical/medical aspects of care and do not entirely capture quality of care. Conclusions Persons living with dementia and their care partners provide important insights into person-centredness and quality of care. Their perspectives on "quality" may differ from clinicians and researchers. Research is needed to better integrate their perspectives in quality improvement and person-centred care.
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Affiliation(s)
- Bryan B Franco
- Department of Medicine, University of Alberta, Edmonton, AB
| | - Veronique M. Boscart
- CIHR/Schlegel Industrial Research Chair for Colleges in Seniors Care, Conestoga College, Kitchener, ON
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Sherry Dupuis
- Partnerships in Dementia Care Alliance and Department of Recreation and Leisure Studies, University of Waterloo, Waterloo, ON
| | | | - Linda Lee
- Schlegel Research Chair in Primary Care for Elders, Conestoga College, Kitchener, ON,Department of Family Medicine, McMaster University, Hamilton, ON
| | - George A. Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON,Schlegel-UW Research Institute for Aging, Waterloo, ON
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Hedman R, Hillerås P, Tyrrell M. Living in uncertainty while a spouse is undergoing a cognitive assessment: Voices of women care partners. DEMENTIA 2022; 21:2631-2646. [PMID: 36131252 PMCID: PMC9583288 DOI: 10.1177/14713012221128448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Women often support partners with cognitive symptoms during the assessment process and when they are receiving a cognitive diagnosis. Living with a partner with cognitive symptoms can be stressful; however, there is limited insights into the specific experiences of older women during the assessment process. Previous research indicates that there are gender differences in the experiences of spousal caregiving; however, further research is needed in regard to the experiences of men and women as care partners. Therefore, the aim of the present study was to describe women's experiences of living with a partner undergoing a cognitive assessment. METHODS Semi-structured interviews were conducted with seven women when their male partners commenced a cognitive assessment and after the assessment had been completed. The interviews were analysed with abductive content analysis. FINDINGS Uncertainty permeated the women's experiences. Antecedents, attributes and strategies to manage the uncertainty were described. CONCLUSION The participants expressed informational and existential uncertainty when their partner underwent a cognitive assessment. A lack of knowledge regarding the assessment process and cognitive diagnoses, especially mild cognitive impairment, was identified. Further, there was a need to process existential uncertainty evoked by the situation.
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Affiliation(s)
- Ragnhild Hedman
- Department of Nursing Science, 25548Sophiahemmet University, Stockholm, Sweden
| | - Pernilla Hillerås
- Red Cross University College, Huddinge, Sweden.,Department of Neurobiology, Care Sciences and Society, 97092Karolinska Institutet, Stockholm, Sweden
| | - Marie Tyrrell
- Department of Nursing Science, 25548Sophiahemmet University, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, 97092Karolinska Institutet, Stockholm, Sweden
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Knox S, Downer B, Haas A, Ottenbacher KJ. Home health utilization association with discharge to community for people with dementia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12341. [PMID: 35910670 PMCID: PMC9322826 DOI: 10.1002/trc2.12341] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 06/15/2022] [Accepted: 07/01/2022] [Indexed: 11/06/2022]
Abstract
Introduction The objective of this study was to identify home health utilization factors associated with successful discharge to community after home health care for patients with and without Alzheimer's disease and related dementias (ADRD). Methods This was a retrospective study of 100% national Medicare home health data files (2016 to 2017). Multilevel logistic regression was used to study the relationship of home health utilization with a modified definition of successful discharge to community (M-SDC) after home health (no readmission or discharge within 30 days). Significant interactions were identified using backward selection. The associations between domains were examined in a model stratified by ADRD, with and without controlling for mobility, self-care, and caregiver assistance. Results The cohort consisted of 535,691 patients, 18.0% with ADRD. The overall M-SDC rate was 92.1%. The likelihood of M-SDC was increased when physical therapy services were provided, episodes of care were longer than 15 days, and the total number of therapy visits was greater than 10. The likelihood of M-SDC decreased when speech therapy, nursing, and home health aide services were provided and when patients were discharged early. When controlling for mobility, self-care, and caregiver support, length of home health episode was the only characteristic that showed a significant interaction with ADRD. Discussion The results of this study indicate that the provision of physical therapy services and moderate lengths of care and volume of visits are associated with increased likelihood of M-SDC. A decreased likelihood of M-SDC when speech therapy, nursing, and home health aide services are delivered may be a proxy indicator of patient acuity and disease severity and needs to be further investigated. An important next step in understanding home health access and outcomes for people with ADRD is to examine the impact of the Patient-Driven Groupings Model on home health utilization characteristics, especially length of episodes. Highlights Most people remain in the community after discharge from home health.Likelihood of modified successful discharge to community (M-SDC) increased with physical therapy, longer episodes, and more than 10 visits.Likelihood of M-SDC decreased with speech therapy, skilled nursing, home health aide visits, and early discharge.Longer home health episodes increased likelihood of M-SDC for people with Alzheimer's disease and related dementias.
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Affiliation(s)
- Sara Knox
- Division of Physical TherapyMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Brian Downer
- Department of NutritionMetabolism & Rehabilitation SciencesUniversity of Texas Medical BranchGalvestonTexasUSA
| | - Allen Haas
- Department of Preventative Medicine and Community HealthUniversity of Texas Medical BranchGalvestonTexasUSA
| | - Kenneth J. Ottenbacher
- Department of NutritionMetabolism & Rehabilitation SciencesUniversity of Texas Medical BranchGalvestonTexasUSA
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Seitz DP, Chan CC, Newton HT, Gill SS, Herrmann N, Smailagic N, Nikolaou V, Fage BA. Mini-Cog for the detection of dementia within a primary care setting. Cochrane Database Syst Rev 2021; 7:CD011415. [PMID: 34261197 PMCID: PMC8406662 DOI: 10.1002/14651858.cd011415.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Alzheimer's disease and other forms of dementia are becoming increasingly common with the aging of most populations. The majority of individuals with dementia will first present for care and assessment in primary care settings. There is a need for brief dementia screening instruments that can accurately detect dementia in primary care settings. The Mini-Cog is a brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings. OBJECTIVES To determine the accuracy of the Mini-Cog for detecting dementia in a primary care setting. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Register of Diagnostic Test Accuracy Studies, MEDLINE, Embase and four other databases, initially to September 2012. Since then, four updates to the search were performed using the same search methods, and the most recent was January 2017. We used citation tracking (using the databases' 'related articles' feature, where available) as an additional search method and contacted authors of eligible studies for unpublished data. SELECTION CRITERIA We only included studies that evaluated the Mini-Cog as an index test for the diagnosis of Alzheimer's disease dementia or related forms of dementia when compared to a reference standard using validated criteria for dementia. We only included studies that were conducted in primary care populations. DATA COLLECTION AND ANALYSIS We extracted and described information on the characteristics of the study participants and study setting. Using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria we evaluated the quality of studies, and we assessed risk of bias and applicability of each study for each domain in QUADAS-2. Two review authors independently extracted information on the true positives, true negatives, false positives, and false negatives and entered the data into Review Manager 5 (RevMan 5). We then used RevMan 5 to determine the sensitivity, specificity, and 95% confidence intervals. We summarized the sensitivity and specificity of the Mini-Cog in the individual studies in forest plots and also plotted them in a receiver operating characteristic plot. We also created a 'Risk of bias' and applicability concerns graph to summarize information related to the quality of included studies. MAIN RESULTS There were a total of four studies that met our inclusion criteria, including a total of 1517 total participants. The sensitivity of the Mini-Cog varied between 0.76 to 1.00 in studies while the specificity varied between 0.27 to 0.85. The included studies displayed significant heterogeneity in both methodologies and clinical populations, which did not allow for a meta-analysis to be completed. Only one study (Holsinger 2012) was found to be at low risk of bias on all methodological domains. The results of this study reported that the sensitivity of the Mini-Cog was 0.76 and the specificity was 0.73. We found the quality of all other included studies to be low due to a high risk of bias with methodological limitations primarily in their selection of participants. AUTHORS' CONCLUSIONS There is a limited number of studies evaluating the accuracy of the Mini-Cog for the diagnosis of dementia in primary care settings. Given the small number of studies, the wide range in estimates of the accuracy of the Mini-Cog, and methodological limitations identified in most of the studies, at the present time there is insufficient evidence to recommend that the Mini-Cog be used as a screening test for dementia in primary care. Further studies are required to determine the accuracy of Mini-Cog in primary care and whether this tool has sufficient diagnostic test accuracy to be useful as a screening test in this setting.
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Affiliation(s)
- Dallas P Seitz
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Calvin Ch Chan
- School of Medicine, Queen's University, Kingston, Canada
| | - Hailey T Newton
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Sudeep S Gill
- Department of Medicine, Queen's University, Kingston, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Nadja Smailagic
- Institute of Public Health, University of Cambridge , Cambridge, UK
| | | | - Bruce A Fage
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Peckham A, Wright JG, Marani H, Abdelhalim R, Laxer D, Allin S, Alam N, Marchildon G. Putting the Patient First: A Scoping Review of Patient Desires in Canada. Healthc Policy 2021; 16:46-69. [PMID: 34129478 PMCID: PMC8200834 DOI: 10.12927/hcpol.2021.26499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.
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Affiliation(s)
- Allie Peckham
- Assistant Professor, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; North American Observatory on Health Systems and Policies, University of Toronto, Toronto, ON
| | - James G Wright
- Chief, Economics, Policy and Research, Ontario Medical Association, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Husayn Marani
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Reham Abdelhalim
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Dara Laxer
- Executive Director, Health Policy and Promotion, Ontario Medical Association, Toronto, ON
| | - Sara Allin
- Director of Operations, North American Observatory on Health Systems and Policies; Assistant Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Nadia Alam
- Past President, Ontario Medical Association, Toronto, ON
| | - Greg Marchildon
- Director, North American Observatory on Health Systems and Policies; Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Multispecialty Interprofessional Team Memory Clinics: Enhancing Collaborative Practice and Health Care Providers' Experience of Dementia Care. Can J Aging 2021; 41:96-109. [PMID: 33926598 DOI: 10.1017/s0714980821000052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This study explored whether working within Multispecialty INterprofessional Team (MINT) memory clinics has an impact on health care professionals' perceptions of the challenges, attitudes, and level of collaboration associated with providing dementia care. Surveys were completed by MINT memory clinic members pre- and 6-months post-clinic launch. A total of 228 pre-and-post-training surveys were matched for analysis. After working in the MINT memory clinics for 6 months, there were significant reductions in mean ratings of the level of challenge associated with various aspects of dementia care, and significant increases in the frequency with which respondents experienced enthusiasm, inspiration, and pride in their work in dementia care and in ratings of the extent of collaboration for dementia care. This study provides some insights into the effect of collaborative, interprofessional approaches on health care professionals' perceptions of the challenges and attitudes associated with providing dementia care and level of collaboration with other health professionals.
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Lee L, Hillier LM, Patel T, Weston WW. A Decade of Dementia Care Training: Learning Needs of Primary Care Clinicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:131-140. [PMID: 32175933 DOI: 10.1097/ceh.0000000000000288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Limited knowledge of dementia among health professionals is a well-documented barrier to optimal care. This study examined the self-perceived challenges with dementia care and learning needs among primary care clinicians and assessed whether these were associated with years of practice and perceived preparedness for dementia care. METHODS Participants were multi-disciplinary clinicians attending a 5-day team-based dementia education program and physicians attending a similar condensed continuing medical education workshop. Pre-education, they completed an online survey in which they rated (5-point scales): interest in learning about various dementia-related topics, perceived challenges with various dementia-related practice activities and preparedness for dementia care, provided additional dementia-related topics of interest, number of years in clinical practice, and discipline. RESULTS Thirteen hundred surveys were completed across both education programs. Mean ratings of preparedness for dementia care across all respondents reflected that they felt somewhat prepared for dementia care. Challenge ratings varied from low to very challenging and mean ratings reflected a high level of interest in learning more about all of the dementia-related topics; significant differences between disciplines in these ratings were identified. In most cases, perceived challenges and learning needs were not correlated with number of years in clinical practice, but in some cases lower ratings of preparedness for dementia care were associated with higher ratings of the challenges of dementia care. DISCUSSION Clinicians perceived that their formal education had not prepared them well for managing dementia and desired more knowledge in all topic areas, regardless of years in practice. Implications for education are discussed.
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Affiliation(s)
- Linda Lee
- Dr. Lee: Lead Physician, MINT Memory Clinic, Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada, Associate Professor, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada, and Schlegel Research Chair in Primary Care for Elders, Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada. Ms. Hillier: Research Affiliate, Geriatric Education and Research in Aging Sciences (GERAS) Centre, Hamilton, Ontario, Canada. Dr. Patel: Pharmacist, MINT Memory Clinic, Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada, and Assistant Clinical Professor, School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada, and Assistant Clinical Professor, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada. Dr. Weston: Professor Emeritus, Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Warrick N, Prorok JC, Seitz D. Care of community-dwelling older adults with dementia and their caregivers. CMAJ 2019; 190:E794-E799. [PMID: 29970368 DOI: 10.1503/cmaj.170920] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Natalie Warrick
- Cancer Care Ontario (Warrick, Prorok, Seitz); Institute of Health Policy, Management and Evaluation (Warrick), University of Toronto, Toronto, Ont.; School of Public Health and Health Systems (Prorok), University of Waterloo, Waterloo, Ont.; Department of Psychiatry (Seitz), Queen's University, Kingston, Ont
| | - Jeanette C Prorok
- Cancer Care Ontario (Warrick, Prorok, Seitz); Institute of Health Policy, Management and Evaluation (Warrick), University of Toronto, Toronto, Ont.; School of Public Health and Health Systems (Prorok), University of Waterloo, Waterloo, Ont.; Department of Psychiatry (Seitz), Queen's University, Kingston, Ont
| | - Dallas Seitz
- Cancer Care Ontario (Warrick, Prorok, Seitz); Institute of Health Policy, Management and Evaluation (Warrick), University of Toronto, Toronto, Ont.; School of Public Health and Health Systems (Prorok), University of Waterloo, Waterloo, Ont.; Department of Psychiatry (Seitz), Queen's University, Kingston, Ont.
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11
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Lee L, Hillier LM, Locklin J, Lumley-Leger K, Molnar F. Specialist and family physician collaboration: Insights from primary care-based memory clinics. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e522-e533. [PMID: 30977237 DOI: 10.1111/hsc.12751] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 03/13/2019] [Accepted: 03/15/2019] [Indexed: 06/09/2023]
Abstract
Given limited available geriatric specialists and complexity of dementia care, there is a need for greater collaboration between primary care and specialists to better meet the needs of persons with dementia. Meaningful family physician-specialist collaboration has the potential to improve health outcomes, timely access to care and more appropriate healthcare resource utilisation. Primary Care Collaborative Memory Clinics (PCCMCs), which include specialist support, provide a significant opportunity for studying the family physician-specialist interface. This study aimed to explore the nature of collaborative relationships between memory clinic family physicians and specialists caring for persons with memory concerns in PCCMCs across Ontario, Canada. Family physicians (N = 71) attending an education session and specialists (N = 21) completed a survey in the fall of 2017 that measured frequency and amount of collaboration, perceptions of their relationship and identified factors that enable and challenge collaboration. Descriptive statistics were generated for quantitative data and themes for responses to open-ended questions were explored using descriptive qualitative content analysis. Specialists and memory clinic family physicians valued their collaboration particularly as related to capacity building for dementia care and desired more time devoted to collaboration. Identified enablers and barriers to collaboration have implications for further integration of specialist support to potentially support improved patient care and further build capacity in primary care to manage dementia care. Opportunities exist for expanding and more intentionally supporting how family physicians and specialists interact with the creation of more formalised processes to support optimal collaboration, including a clear delineation of roles, responsibilities and expectations, more formally planned and structured relationship building and monitoring, identifying and addressing unique barriers to collaboration and use of a variety of methods of communication. Study findings have implications for how specialists and family physicians communicate and collaborate in other programmes for complex chronic conditions.
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Affiliation(s)
- Linda Lee
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Loretta M Hillier
- Geriatric Education and Research in Aging Sciences (GERAS) Centre, Hamilton, Ontario, Canada
| | - Jason Locklin
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
| | | | - Frank Molnar
- Regional Geriatric Program of Eastern Ontario, Ottawa, Ontario, Canada
- Division of Geriatrics, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
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Tierney L, Mason R, Doherty K, Winbolt M, Long M, Robinson A. Workshops on diagnosis and management of dementia for general practitioners: a pre-post intervention study of dementia knowledge. BMJ Open 2019; 9:e027804. [PMID: 30967411 PMCID: PMC6500330 DOI: 10.1136/bmjopen-2018-027804] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/18/2019] [Accepted: 03/06/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess improvements in dementia knowledge among general practitioner (GP) registrars and supervisors following their participation in dementia workshops. DESIGN Pre-post intervention study. SETTING General practice education in Australia. PARTICIPANTS 296 GP registrars and 91 GP supervisors. INTERVENTIONS Registrars participated in a 3-hour face-to-face workshop on diagnosing and managing dementia. Supervisors participated in a 2-hour modified version of the workshop designed to support them in teaching registrars. MAIN OUTCOME MEASURES The Dementia Knowledge Assessment Scale (DKAS) was used to assess overall dementia knowledge as well as knowledge on four subscales (causes and characteristics; communication and behaviour; care considerations; risks and health promotion). Changes in mean scores and the proportion of participants obtaining a threshold score (90th percentile score preworkshop) were used as measures of improvement. RESULTS Few registrars and supervisors identified previous experience of formal dementia education. At baseline, mean dementia knowledge scores were 36 for registrars and 37 for supervisors of a total score of 50. Both groups had significantly improved overall dementia knowledge following the workshop with a mean score of 43. Improvements in knowledge were observed for all four DKAS subscales. Between preworkshop and postworkshop periods, there was an increase in the proportion of registrars and supervisors obtaining the threshold score for total DKAS as well as the four subscales. A significantly higher proportion of registrars compared with supervisors obtained the threshold score postworkshop in the areas of causes and characteristics and risks and health promotion. CONCLUSIONS Prior to the workshop, no differences in overall dementia knowledge were observed between registrars and supervisors. While knowledge improved in all areas for both groups postworkshop, findings from this study suggest the need to include foundational content such as the causes and characteristics of dementia in educational workshops for both trainee and experienced GPs.
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Affiliation(s)
- Laura Tierney
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Ron Mason
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Kathleen Doherty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Margaret Winbolt
- Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Victoria, Australia
| | - Marita Long
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew Robinson
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
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Lee L, Lu SK, Hillier LM, Gregg S, Kaufman Carlin G. Improving access to community support and services for persons living with dementia: Integration of home care services into primary care-based memory clinics. Geriatr Gerontol Int 2019; 19:81-82. [DOI: 10.1111/ggi.13572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/17/2018] [Accepted: 10/08/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Linda Lee
- Center for Family Medicine Family Health Team; Kitchener Ontario Canada
- Department of Family Medicine; McMaster University; Hamilton Ontario Canada
| | - Stephanie K Lu
- Center for Family Medicine Family Health Team; Kitchener Ontario Canada
| | - Loretta M Hillier
- Geriatric Education and Research in Aging Sciences (GERAS) Center; Hamilton Health Sciences Centre; Hamilton Ontario Canada
| | - Susie Gregg
- Canadian Mental Health Association Waterloo Wellington; Guelph Ontario Canada
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Lee L, Slonim K, Hillier LM, Lu SK, Lee J. Persons with dementia and care partners’ perspectives on memory clinics in primary care. Neurodegener Dis Manag 2018; 8:385-397. [DOI: 10.2217/nmt-2018-0024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aims: To understand persons with dementia (PWD) and care partners’ experiences with the Primary Care Collaborative Memory Clinic (PCCMC) care model. Methods: Interviews were conducted with a purposeful sample of PWD (n = 12) and care partners (N = 16) to identify their perspectives of care received in the clinic and suggestions for improvement. Results: PWD and care partners were satisfied with care received within the PCCMC, had positive interactions with and perceived a strong sense of support from team members and felt listened to; the necessity of cognitive testing was recognized but disliked. Conclusions: The PCCMC care model can address many existing gaps in dementia care as experienced by PWD and care partners.
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Affiliation(s)
- Linda Lee
- Centre for Family Medicine Family Health Team, McMaster University, 10 B Victoria Street South, Kitchener, N2G 1C5 Ontario, Canada
- Department of Family Medicine, Faculty of Medicine, McMaster University, 100 Main St W, Hamilton, L8P 1H6 Ontario, Canada
| | - Karen Slonim
- Centre for Family Medicine Family Health Team, McMaster University, 10 B Victoria Street South, Kitchener, N2G 1C5 Ontario, Canada
| | - Loretta M Hillier
- Geriatric Education & Research in Aging Sciences (GERAS) Centre, St. Peter's Hospital, 88 Maplewood Ave, Hamilton, L8M 1W9 Ontario, Canada
| | - Stephanie K Lu
- Centre for Family Medicine Family Health Team, McMaster University, 10 B Victoria Street South, Kitchener, N2G 1C5 Ontario, Canada
| | - Jennifer Lee
- Centre for Family Medicine Family Health Team, McMaster University, 10 B Victoria Street South, Kitchener, N2G 1C5 Ontario, Canada
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Jennings AA, Foley T, Walsh KA, Coffey A, Browne JP, Bradley CP. General practitioners' knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia: A mixed-methods systematic review. Int J Geriatr Psychiatry 2018; 33:1163-1176. [PMID: 29900592 PMCID: PMC6099359 DOI: 10.1002/gps.4918] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/03/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To synthesise the existing published literature on general practitioners (GP)'s knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia (BPSD) with a view to informing future interventions. METHODS We conducted a systematic review and synthesis of quantitative and qualitative studies that explored GPs' experiences of managing BPSD (PROSPERO protocol registration CRD42017054916). Seven electronic databases were searched from inception to October 2017. Each stage of the review process involved at least 2 authors working independently. The meta-ethnographic approach was used to synthesise the findings of the included studies while preserving the context of the primary data. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to assess the confidence in our individual review findings. RESULTS Of the 1638 articles identified, 76 full texts were reviewed and 11 were included. Three main concepts specific to GPs' experiences of managing BPSD emerged: unmet primary care resource needs, justification of antipsychotic prescribing, and the pivotal role of families. A "line of argument" was drawn, which described how in the context of resource limitations a therapeutic void was created. This resulted in GPs being over reliant on antipsychotics and family caregivers. These factors appeared to culminate in a reactive response to BPSD whereby behaviours and symptoms could escalate until a crisis point was reached. CONCLUSION This systematic review offers new insights into GPs' perspectives on the management of BPSD and will help to inform the design and development of interventions to support GPs managing BPSD.
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Affiliation(s)
- Aisling A. Jennings
- Department of General Practice, School of MedicineUniversity College CorkCorkIreland
| | - Tony Foley
- Department of General Practice, School of MedicineUniversity College CorkCorkIreland
| | - Kieran A. Walsh
- School of Public HealthUniversity College CorkCorkIreland
- Pharmaceutical Care Research Group, School of PharmacyUniversity College CorkCorkIreland
- Centre for Gerontology and Rehabilitation, School of MedicineUniversity College CorkCorkIreland
| | - Alice Coffey
- Department of Nursing and MidwiferyUniversity of LimerickLimerickIreland
| | - John P. Browne
- School of Public HealthUniversity College CorkCorkIreland
| | - Colin P. Bradley
- Department of General Practice, School of MedicineUniversity College CorkCorkIreland
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Armas A, Meyer SB, Corbett KK, Pearce AR. Face-to-face communication between patients and family physicians in Canada: A scoping review. PATIENT EDUCATION AND COUNSELING 2018; 101:789-803. [PMID: 29173960 DOI: 10.1016/j.pec.2017.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/07/2017] [Accepted: 11/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Patient-provider communication is critical in primary care. Canada's unique health system, population distribution, and cultural context suggest there is value in addressing the topic in the Canadian context. We conducted a scoping review to synthesize recent Canadian literature to inform practice in primary care settings and identify research agendas for patient-provider communication in Canada. METHODS Using Arksey and O'Malley's framework we searched four literature databases: Medline, Web of Science, CINAHL and EMBASE. We extracted 21,932 articles published between 2010 and 2017. A total of 108 articles met the inclusion criteria. The articles were analyzed qualitatively using thematic analysis to identify major themes. RESULTS Four major themes were identified: information sharing, relationships, health system challenges, and development and use of communication tools. CONCLUSION Our review identified a need for Canadian research regarding: communication in primary care with Aboriginal, immigrant, and rural populations; the impact of medical tourism on primary care; and how to improve communication to facilitate continuity of care. PRACTICE IMPLICATIONS Challenges providers face in primary care in Canada include: communicating with linguistically and culturally diverse populations; addressing issues that emerge with the rise of medical tourism; a need for decision aids to improve communication with patients.
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Affiliation(s)
- Alana Armas
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Kitty K Corbett
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Alex R Pearce
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Seitz DP, Chan CCH, Newton HT, Gill SS, Herrmann N, Smailagic N, Nikolaou V, Fage BA. Mini-Cog for the diagnosis of Alzheimer's disease dementia and other dementias within a primary care setting. Cochrane Database Syst Rev 2018; 2:CD011415. [PMID: 29470861 PMCID: PMC6491332 DOI: 10.1002/14651858.cd011415.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Alzheimer's disease and other forms of dementia are becoming increasingly common with the aging of most populations. The majority of individuals with dementia will first present for care and assessment in primary care settings. There is a need for brief dementia screening instruments that can accurately diagnose dementia in primary care settings. The Mini-Cog is a brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings. OBJECTIVES To determine the diagnostic accuracy of the Mini-Cog for diagnosing Alzheimer's disease dementia and related dementias in a primary care setting. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Register of Diagnostic Test Accuracy Studies, MEDLINE, Embase and four other databases, initially to September 2012. Since then, four updates to the search were performed using the same search methods, and the most recent was January 2017. We used citation tracking (using the databases' 'related articles' feature, where available) as an additional search method and contacted authors of eligible studies for unpublished data. SELECTION CRITERIA We only included studies that evaluated the Mini-Cog as an index test for the diagnosis of Alzheimer's disease dementia or related forms of dementia when compared to a reference standard using validated criteria for dementia. We only included studies that were conducted in primary care populations. DATA COLLECTION AND ANALYSIS We extracted and described information on the characteristics of the study participants and study setting. Using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria we evaluated the quality of studies, and we assessed risk of bias and applicability of each study for each domain in QUADAS-2. Two review authors independently extracted information on the true positives, true negatives, false positives, and false negatives and entered the data into Review Manager 5 (RevMan 5). We then used RevMan 5 to determine the sensitivity, specificity, and 95% confidence intervals. We summarized the sensitivity and specificity of the Mini-Cog in the individual studies in forest plots and also plotted them in a receiver operating characteristic plot. We also created a 'Risk of bias' and applicability concerns graph to summarize information related to the quality of included studies. MAIN RESULTS There were a total of four studies that met our inclusion criteria, including a total of 1517 total participants. The sensitivity of the Mini-Cog varied between 0.76 to 1.00 in studies while the specificity varied between 0.27 to 0.85. The included studies displayed significant heterogeneity in both methodologies and clinical populations, which did not allow for a meta-analysis to be completed. Only one study (Holsinger 2012) was found to be at low risk of bias on all methodological domains. The results of this study reported that the sensitivity of the Mini-Cog was 0.76 and the specificity was 0.73. We found the quality of all other included studies to be low due to a high risk of bias with methodological limitations primarily in their selection of participants. AUTHORS' CONCLUSIONS There is a limited number of studies evaluating the accuracy of the Mini-Cog for the diagnosis of dementia in primary care settings. Given the small number of studies, the wide range in estimates of the accuracy of the Mini-Cog, and methodological limitations identified in most of the studies, at the present time there is insufficient evidence to recommend that the Mini-Cog be used as a screening test for dementia in primary care. Further studies are required to determine the accuracy of Mini-Cog in primary care and whether this tool has sufficient diagnostic test accuracy to be useful as a screening test in this setting.
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Affiliation(s)
- Dallas P Seitz
- Queen's UniversityDepartment of Psychiatry752 King Street WestKingstonONCanadaK7L 4X3
| | - Calvin CH Chan
- Queen's UniversitySchool of Medicine49 King Street EastKingstonONCanadaK7L 2Z5
| | - Hailey T Newton
- Queen's UniversityDepartment of Psychiatry752 King Street WestKingstonONCanadaK7L 4X3
| | - Sudeep S Gill
- Queen's UniversityDepartment of MedicineSt. Mary's of the Lake Hospital340 Union StreetKingstonONCanadaK7L 5A2
| | - Nathan Herrmann
- Sunnybrook Research InstituteHurvitz Brain Sciences Research Program2075 Bayview AvenueRoom FG‐05TorontoONCanadaM4N 3M5
| | - Nadja Smailagic
- University of CambridgeInstitute of Public HealthForvie SiteRobinson WayCambridgeUKCB2 0SR
| | | | - Bruce A Fage
- University of TorontoDepartment of PsychiatryTorontoONCanada
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