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Wollney EN, Bylund CL, Bedenfield N, Parker ND, Rosselli M, Curiel Cid RE, Kitaigorodsky M, Armstrong MJ. Persons living with dementia and caregivers' communication preferences for receiving a dementia diagnosis. PEC INNOVATION 2024; 4:100253. [PMID: 38298558 PMCID: PMC10828581 DOI: 10.1016/j.pecinn.2024.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/19/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024]
Abstract
Objective As the number of individuals diagnosed with dementia increases, so does the need to understand the preferences of persons living with dementia (PLWD) and caregivers for how clinicians can deliver a dementia diagnosis effectively, which can be a difficult process. This study describes the diagnostic communication preferences of PLWD and caregivers. Methods We conducted semi-structured individual phone interviews with two groups: PLWD who were diagnosed in the past two years (n = 11) and family caregivers of PLWD (n = 19) living in Florida. PLWD and caregivers were not recruited/enrolled as dyads. Results The groups' communication preferences were largely similar. Data were analyzed thematically into five themes: communicate the diagnosis clearly, meet information needs, discuss PLWD/caregiver resources, prepare for continued care, and communicate to establish and maintain relationships. Conclusion Participants wanted clear communication, information, and support, but differed in some details (e.g. the language used to describe the diagnosis and the amount/type of desired information). Clinicians can apply general principles but will need to tailor them to individual preferences of PLWD and caregivers. Innovation Limited research has elicited PLWD and caregivers' communication preferences for receiving dementia diagnoses, particularly through an individualized data collection method allowing for richer descriptions and deeper understanding.
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Affiliation(s)
- Easton N. Wollney
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Carma L. Bylund
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Noheli Bedenfield
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Naomi D. Parker
- College of Journalism & Communication, University of Florida, Gainesville, FL, United States of America
| | - Mónica Rosselli
- Department of Psychology, Florida Atlantic University, Boca Raton, FL, United States of America
| | - Rosie E. Curiel Cid
- Department of Psychiatry & Behavioral Sciences, Center for Cognitive Neuroscience and Aging, Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | | | - Melissa J. Armstrong
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States of America
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White J, Norton G, Pond D, Khaing K, Dolja-Gore X, Byles J, Carey M. General practitioner and practice nurses perspectives on implementation of the 75+ health assessment: Implications for dementia care and well-being. J Adv Nurs 2024. [PMID: 39073187 DOI: 10.1111/jan.16354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 07/04/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND The uptake of the health assessment for persons aged 75 years and older (75 + HA) remains low. Repeat assessments provide an opportunity to identify areas of change in cognitive function which may mark the onset of dementia. We aimed to explore general practitioner (GP) and practice nurse experiences of implementing the 75 + HA with a focus on clinical considerations for dementia care. METHODS An interpretative qualitative study involving interviews with 15 GPs (female = 11, male = 4) and 5 practice nurses (all female). Data were analysed using an inductive thematic approach. RESULTS The majority of GPs (n = 11) worked in metropolitan settings and four GPs worked in regional settings across NSW. All participants worked in separate clinics, except for two GPs and one practice nurse who worked within the same metropolitan clinic. Distinct themes emerged regarding participants experiences of implementing the 75 + HA for patients with dementia: (1) negotiating aged care is complex and facilitated by a comprehensive assessment; (2) implementing work practices that support the 75 + HA in patients with cognitive decline; and (3) variations in follow up of findings and implications for care. DISCUSSION The 75 + HA provides an opportunity for monitoring and acting on emergent physical and cognitive health changes. Increased engagement and support towards implementing the 75 + HA, particularly in the context of dementia, may facilitate the instigation of interventions. While some participants in this study were confident with identifying and managing cognitive decline, the majority relied on geriatricians to confirm dementia diagnosis and refer to community support services. We suggest the need for greater initiatives and clinical guidelines to assist GPs in the identification and management of cognitive decline. IMPLICATIONS FOR THE PROFESSION From a nursing perspective, this study highlights the valuable role of nurses towards assessment and management of issues raised in the health assessment for persons aged 75 years and older. However, more resources are needed to enable nurse time for adequate follow-up care.
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Affiliation(s)
- Jennifer White
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Centre for Women's Health Research, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Grace Norton
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Centre for Women's Health Research, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Dimity Pond
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kay Khaing
- Centre for Women's Health Research, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Xenia Dolja-Gore
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Centre for Women's Health Research, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Julie Byles
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Centre for Women's Health Research, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Mariko Carey
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Centre for Women's Health Research, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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Brière-Dulude S, Melgares L, Labourot J, Deslauriers T, Gélinas I, Layani G, Vachon B. [Sondage sur les pratiques des médecins de famille et sur la collaboration interprofessionnelle avec des ergothérapeutes en GMF quant au dépistage des conducteurs à risque]. Can J Aging 2024; 43:266-274. [PMID: 37960933 DOI: 10.1017/s0714980823000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Cette étude a sondé 46 médecins de famille québécois quant à leurs pratiques pour l'évaluation et le dépistage des conducteurs à risque afin 1) de mieux comprendre leur niveau de compétence perçu; 2) de recenser les difficultés rencontrées dans le processus de prise de décision et 3) de documenter leurs besoins et attitudes quant à une collaboration plus étroite avec les ergothérapeutes. Les participants (femmes : 84,8 %; moyenne d'expérience : 15,7 (±12,1) ans) ont répondu à un sondage en ligne de 30 questions. Les résultats de cette étude démontrent que malgré un certain confort à effectuer l'évaluation et le dépistage des conducteurs à risque, les médecins ne se considèrent pas comme les professionnels les mieux qualifiés pour ce faire. Ils reconnaissent également le rôle que jouent les ergothérapeutes dans le dépistage de cette clientèle et l'intervention auprès d'elle. Ils voient ainsi la pertinence d'avoir accès aux services de ces professionnels en soins de première ligne.
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Affiliation(s)
| | - Lucas Melgares
- École de réadaptation, Université de Montréal, 7077 Av du Parc, Montréal, QCH3N 1X7
| | - Justine Labourot
- École de réadaptation, Université de Montréal, 7077 Av du Parc, Montréal, QCH3N 1X7
| | - Tania Deslauriers
- École de réadaptation, Université de Montréal, 7077 Av du Parc, Montréal, QCH3N 1X7
| | - Isabelle Gélinas
- School of Physical and Occupational Therapy, Université McGill, Davis House l 3654 Prom. Sir William Osler l Montreal, QuebecH3G 1Y5
| | - Géraldine Layani
- Département de médecine de famille et de médecine d'urgence, Université de Montréal, 2900, boul. Édouard-Montpetit, Montréal (Québec) H3T 1J4
| | - Brigitte Vachon
- École de réadaptation, Université de Montréal, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7077 Av du Parc, Montréal, QCH3N 1X7
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Dufour I, Brodeur S, Courteau J, Roy MA, Vanasse A, Quesnel-Vallee A, Vedel I. Care trajectories around a first dementia diagnosis in patients with serious mental illness. Geriatr Gerontol Int 2024; 24:577-586. [PMID: 38710639 DOI: 10.1111/ggi.14889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/19/2024] [Accepted: 04/21/2024] [Indexed: 05/08/2024]
Abstract
AIM To develop a typology of care trajectories (CTs) 1 year before and after a first dementia diagnosis in individuals aged ≥65 years, with prevalent schizophrenia or bipolar disorder. METHODS This was a longitudinal, retrospective cohort study using health administrative data (1996-2016) from Quebec (Canada). We selected patients aged ≥65 years with an incident diagnosis of dementia between 1 January 2014 and 31 December 2016, and a diagnosis of schizophrenia and/or or bipolar disorder. A CT typology was generated by a multidimensional state sequence analysis based on the "6 W" model of CTs. Three dimensions were considered: the care setting ("where"), the reason for consultation ("why") and the specialty of care providers ("which"). RESULTS In total, 3868 patients were categorized into seven distinct types of CTs, with varying patterns of healthcare use and comorbidities. Healthcare use differed in terms of intensity, but also in its distribution around the diagnosis. For instance, whereas one group showed low healthcare use, healthcare use abruptly increased or decreased after the diagnosis in other groups, or was equally distributed. Other significant differences between CTs included mortality rates and use of long-term care after the diagnosis. Most patients (67%) received their first dementia diagnosis during hospitalization. CONCLUSIONS Our innovative approach provides a unique insight into the complex healthcare patterns of people living with serious mental illness and dementia, and provides an avenue to support data-driven decision-making by highlighting fragility areas in allocating care resources. Geriatr Gerontol Int 2024; 24: 577-586.
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Affiliation(s)
- Isabelle Dufour
- Nursing School, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Research Center on Aging, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Sébastien Brodeur
- Department of Psychiatry and Neurosciences, Université Laval, Québec City, Québec, Canada
| | - Josiane Courteau
- PRIMUS Research group, CHUS Research center, Sherbrooke, Québec, Canada
| | - Marc-André Roy
- Department of Psychiatry and Neurosciences, Université Laval, Québec, Québec, Canada
- CERVO Brain Research Group, Québec, Québec, Canada
| | - Alain Vanasse
- PRIMUS Research group, CHUS Research center, Sherbrooke, Québec, Canada
- Department of Family and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Amélie Quesnel-Vallee
- Department of Sociology, Faculty of Arts, McGill University, Montreal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
- McGill Observatory on Health and Social Services Reforms, Montreal, Québec, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
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Morgan DG, Kosteniuk J, Bayly M. Perceptions and outcomes of an embedded Alzheimer Society First Link Coordinator in rural primary health care memory clinics. BMC Health Serv Res 2024; 24:607. [PMID: 38724975 PMCID: PMC11080231 DOI: 10.1186/s12913-024-11066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Primary health care has a central role in dementia detection, diagnosis, and management, especially in low-resource rural areas. Care navigation is a strategy to improve integration and access to care, but little is known about how navigators can collaborate with rural primary care teams to support dementia care. In Saskatchewan, Canada, the RaDAR (Rural Dementia Action Research) team partnered with rural primary health care teams to implement interprofessional memory clinics that included an Alzheimer Society First Link Coordinator (FLC) in a navigator role. Study objectives were to examine FLC and clinic team member perspectives of the impact of FLC involvement, and analysis of Alzheimer Society data comparing outcomes associated with three types of navigator-client contacts. METHODS This study used a mixed-method design. Individual semi-structured interviews were conducted with FLC (n = 3) and clinic team members (n = 6) involved in five clinics. Data were analyzed using thematic inductive analysis. A longitudinal retrospective analysis was conducted with previously collected Alzheimer Society First Link database records. Memory clinic clients were compared to self- and direct-referred clients in the geographic area of the clinics on time to first contact, duration, and number of contacts. RESULTS Three key themes were identified in both FLC and team interviews: perceived benefits to patients and families of FLC involvement, benefits to memory clinic team members, and impact of rural location. Whereas other team members assessed the patient, only FLC focused on caregivers, providing emotional and psychological support, connection to services, and symptom management. Face-to-face contact helped FLC establish a relationship with caregivers that facilitated future contacts. Team members were relieved knowing caregiver needs were addressed and learned about dementia subtypes and available services they could recommend to non-clinic clients with dementia. Although challenges of rural location included fewer available services and travel challenges in winter, the FLC role was even more important because it may be the only support available. CONCLUSIONS FLC and team members identified perceived benefits of an embedded FLC for patients, caregivers, and themselves, many of which were linked to the FLC being in person.
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Affiliation(s)
- Debra G Morgan
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, 104 Clinic Place, Box 23, Saskatoon, SK, S7N 5E5, Canada.
| | - Julie Kosteniuk
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, 104 Clinic Place, Box 23, Saskatoon, SK, S7N 5E5, Canada
| | - Melanie Bayly
- Research Ethics Office, Human Ethics, University of Saskatchewan, 2nd Floor, Thorvaldson Building, 110 Science Place, Saskatoon, SK, S7N 5C9, Canada
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Gibson C, Goeman D, Pond D, Yates M, Hutchinson A. General practice nurse perceptions of barriers and facilitators to implementation of best-practice dementia care recommendations-a qualitative interview study. BMC PRIMARY CARE 2024; 25:147. [PMID: 38698316 PMCID: PMC11064280 DOI: 10.1186/s12875-024-02401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/23/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION With an aging population and a growing prevalence of people living with dementia, the demand for best-practice dementia care in general practice increases. There is an opportunity to better utilise the nurse role within the primary care team to meet this increasing demand in the provision of care for people living with dementia. However, general practice nurses have limited knowledge in the provision of best-practice care for people living with dementia and their carer(s). A number of best-practice dementia care recommendations contained in the Australian Clinical Practice Guidelines and Principles of Care for People with Dementia have been identified as highly relevant to the role of the general practice nurse. AIMS To explore general practice nurses' perspectives on published best-practice dementia care recommendations relevant to their role and identify barriers and facilitators to their implementation into clinical practice. METHODS Thirteen Australian general practice nurses took part in this qualitative interview study. The research questions for this study were addressed within a paradigmatic framework of social constructionism. Data were transcribed verbatim and thematically analysed. RESULTS There was a high level of agreement between general practice nurses that the recommendations were important, reflected best-practice dementia care and were relevant to their role. However the recommendations were perceived as limited in their usefulness to nurses' clinical practice due to being too vague and lacking direction. Four main themes were identified describing barriers and facilitators to operationalising best-practice dementia care.: creating a comfortable environment; changing approach to care; optimising the general practice nurse role and working collaboratively. Nine sub-themes were described: physical environment; social environment; complexity of care; care planning for the family; professional role and identity, funding better dementia care, education, networking and resources; different roles, one team; and interagency communication. CONCLUSION This study identified several factors that need addressing to support general practice nurses to integrate best-practice dementia care recommendations into daily clinical practice. The development of interventions needs to include strategies to mitigate potential barriers and enhance facilitators that they perceive impact on their delivery of best-practice care for people living with dementia and their carer(s). The knowledge gained in this study could be used to develop multi-faceted interventions informed by theoretical implementation change models to enable the general practice nurse to operationalise best-practice dementia care recommendations.
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Affiliation(s)
- Caroline Gibson
- University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, 2308, Australia.
- Grampians Health, Ballarat, Australia.
| | - Dianne Goeman
- University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, 2308, Australia
- Faculty of Medicine, Nursing and Health Sciences, The Alfred Centre, Melbourne, Monash University, Clayton, Australia
| | - Dimity Pond
- University of Tasmania, Wicking Dementia and Teaching Centre, Hobart, Australia
| | - Mark Yates
- Deakin University, School of Medicine, Geelong, Australia
- Grampians Health, Ballarat, Australia
| | - Alison Hutchinson
- Deakin University, School of Nursing and Midwifery, Burwood, Australia
- Faculty of Medicine, Nursing and Health Sciences, The Alfred Centre, Melbourne, Monash University, Clayton, Australia
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Alsalem ZA, Alghathber NM, Alowain FS, Alqahtani MS, Alharbi NG. Dementia Knowledge Among Primary Healthcare Physicians in Riyadh, Saudi Arabia. Cureus 2024; 16:e61112. [PMID: 38800780 PMCID: PMC11128245 DOI: 10.7759/cureus.61112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Dementia poses a significant healthcare challenge globally, and healthcare providers must have adequate knowledge about its diagnosis, management, and support services. By assessing the knowledge level of primary care physicians in Riyadh, we can identify potential gaps and areas for improvement in dementia care, ultimately enhancing patient outcomes and quality of life. This study holds promise in shedding light on the current state of dementia knowledge among primary healthcare physicians in Riyadh and offering insights into strategies to enhance dementia care in this region. METHODS This cross-sectional questionnaire-based study was conducted from the first of June 2023 to the end of December 2023 in Riyadh, Saudi Arabia. A validated questionnaire was used to assess physicians' knowledge, attitude, and practice toward dementia. RESULTS A total of 151 physicians completed the questionnaires. The majority were male (55%), below 30 years of age (88.1%), and family medicine residents (84.8%). Most (74.8%) recognized old age as the most significant risk factor; an overwhelming majority of participants (98.7%) could not identify the minimum course of treatment to judge a medication's effectiveness. The average score of correct responses (7.74 ∓ 4.11) was equivalent to 38.7%. Furthermore, the average correct responses were significantly different among the different job levels of the participants. CONCLUSIONS The findings of this study highlight a lack of knowledge among primary care physicians regarding dementia, emphasizing the crucial importance of physician education in this area. Additionally, the results strongly indicate the need for emphasis on dementia education within the undergraduate medical curriculum, family medicine curriculum, and physician training programs. By addressing these educational gaps, we can better equip physicians to provide optimal care and support for individuals with dementia, ultimately improving patient care and quality of life.
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Armstrong MJ, Bedenfield N, Rosselli M, Curiel Cid RE, Kitaigorodsky M, Galvin JE, Lachner C, Grant Smith A, de Los Ángeles Ortega M, Mohiuddin Y, Shatzer J, Marasco D, Willis D, Bylund CL. Best Practices for Communicating a Diagnosis of Dementia: Results of a Multi-Stakeholder Modified Delphi Consensus Process. Neurol Clin Pract 2024; 14:e200223. [PMID: 38152063 PMCID: PMC10750429 DOI: 10.1212/cpj.0000000000200223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/04/2023] [Indexed: 12/29/2023]
Abstract
Background and Objectives Many individuals with dementia and their families report not receiving a dementia diagnosis. Previously published standards for delivering a dementia diagnosis are now more than 10 years old and were developed without patient and caregiver input. The objective of this study was to identify best practices for delivering a diagnosis of dementia using existing literature, involvement of diverse stakeholders, and consensus building through a formal modified Delphi approach. Methods We convened a multi-stakeholder working group including a patient, caregivers, Alzheimer's Association staff, and clinicians from diverse backgrounds. The panel used the American Academy of Neurology process for recommendation development, consisting of a half-day workshop and 3 rounds of anonymous modified Delphi voting to achieve consensus. Results The working group convened from May 2022 through January 2023. The group chose to focus statements on a limited number of best practices that can be applied across clinic types. Seven best practice statements achieved consensus after a maximum of 3 rounds of voting. These included the following: (1) Clinicians must show compassion and empathy when delivering a diagnosis of dementia (level A). During dementia diagnosis disclosure, clinicians should (2) ask regarding diagnosis preferences, (3) instill realistic hope, (4) provide practical strategies, (5) provide education and connections to high-quality resources, (6) connect caregivers to support resources, and (7) provide written summaries of the diagnoses, plan, and relevant resources (each level B). Discussion Clinicians need to customize discussion of a dementia diagnosis for individual patients and their caregivers. These 7 best practices provide a diagnosis communication framework that can be implemented across varied clinical settings. Additional strategies, such as using optimal general communication approaches, are also important for dementia diagnosis discussions. Thoughtful application of these best practices is particularly important when caring for individuals from underrepresented communities. Further improving communication regarding dementia diagnoses will require health system changes (e.g., for sufficient time), improved access to specialty dementia care, and clinician training for delivering difficult diagnoses. More research is needed to identify culturally sensitive approaches to discussing dementia diagnoses.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Noheli Bedenfield
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Monica Rosselli
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Rosie E Curiel Cid
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Marcela Kitaigorodsky
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - James E Galvin
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Christian Lachner
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Amanda Grant Smith
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - María de Los Ángeles Ortega
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Yasmin Mohiuddin
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Julie Shatzer
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Deann Marasco
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Dianna Willis
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Carma L Bylund
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
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9
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Pham BD, Kim BG, Esterman A, Brodaty H, Kurrle S, Nguyen TB, Nguyen TH, Roughead E, Hinton L, Dang TH, Nguyen TDH, Tran K, Crotty M, Du D, Nguyen TA. Knowledge, attitudes and self-confidence with skills required for providing dementia care in physicians at primary healthcare settings in Vietnam. BMC Health Serv Res 2024; 24:86. [PMID: 38233921 PMCID: PMC10792887 DOI: 10.1186/s12913-023-10460-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Dementia is a global public health priority. The World Health Organization adopted a Global Action Plan on Dementia, with dementia awareness a priority. This study examined the knowledge, attitudes, and self-confidence with skills required for providing dementia care among primary health care providers in Vietnam. METHODS A cross-sectional study was conducted with 405 primary health care providers who worked at commune health stations and district health centers in eight provinces across Vietnam. RESULTS The results showed that primary health care providers had poor knowledge and little confidence but more positive attitudes toward dementia care and management. CONCLUSIONS The results suggest the training needs for building capacity amongst primary health care providers, which will be critical as Vietnam's population ages.
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Affiliation(s)
- Bich Diep Pham
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Bao Giang Kim
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
| | - Adrian Esterman
- UniSA: Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Susan Kurrle
- The University of Sydney, Sydney, NSW, Australia
| | | | | | - Elizabeth Roughead
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ladson Hinton
- University of California, Davis, Sacramento, CA, USA
| | - Thu Ha Dang
- Swinburne University of Technology, Melbourne, VIC, Australia
- National Ageing Research Institute, Melbourne, VIC, Australia
| | - Thi Diem Huong Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Kham Tran
- National Ageing Research Institute, Melbourne, VIC, Australia
- Flinders University, Adelaide, SA, Australia
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | | | - Duc Du
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tuan Anh Nguyen
- Swinburne University of Technology, Melbourne, VIC, Australia
- National Ageing Research Institute, Melbourne, VIC, Australia
- Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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10
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Mace RA, Lyons C, Cohen JE, Ritchie C, Bartels S, Okereke OI, Hoeppner BB, Brewer JA, Vranceanu AM. Optimizing the Implementation of a Lifestyle Dementia Prevention Intervention for Older Patients in an Academic Healthcare System. J Alzheimers Dis 2024; 100:1237-1259. [PMID: 39031363 DOI: 10.3233/jad-240365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
Background Interventions that promote healthy lifestyles are critical for the prevention of Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD). However, knowledge of the best practices for implementing AD/ADRD prevention in healthcare settings remains limited. Objective We aimed to qualitatively identify barriers and facilitators to implementing a clinical trial of a novel lifestyle intervention (My Healthy Brain) in our medical center for older patients with subjective cognitive decline who are at-risk for AD/ADRD. Methods We conducted focus groups with 26 healthcare professionals (e.g., physicians, psychology, nursing) from 5 clinics that treat older patients (e.g., memory care, psychiatry). Our qualitative analysis integrated two implementation frameworks to systematically capture barriers and facilitators to AD/ADRD prevention (Consolidated Framework for Implementation Science Research) that impact implementation outcomes of acceptability, appropriateness, and feasibility (Proctor's framework). Results We found widespread support for an RCT of My Healthy Brain and AD/ADRD prevention. Participants identified barriers related to patients (stigma, technological skills), providers (dismissiveness of "worried well," doubting capacity for behavior change), clinics (limited time and resources), and the larger healthcare system (underemphasis on prevention). Implementation strategies guided by Expert Recommendations for Implementing Change (ERIC) included: developing tailored materials, training staff, obtaining buy-in from leadership, addressing stigmatized language and practices, identifying "champions," and integrating with workflows and resources. Conclusions The results will inform our recruitment, enrollment, and retention procedures to implement the first randomized clinical trial of My Healthy Brain. Our study provides a blueprint for addressing multi-level barriers to the implementation of AD/ADRD prevention for older patients in medical settings.
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Affiliation(s)
- Ryan A Mace
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (CHOIR), Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher Lyons
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (CHOIR), Massachusetts General Hospital, Boston, MA, USA
| | - Joshua E Cohen
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (CHOIR), Massachusetts General Hospital, Boston, MA, USA
| | - Christine Ritchie
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen Bartels
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Olivia I Okereke
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Bettina B Hoeppner
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Judson A Brewer
- Mindfulness Center, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (CHOIR), Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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11
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Erickson CM, Chin NA, Ketchum FB, Eveler ML, Conway CE, Coughlin DM, Clark LR. The Room Where It Happens: Clinician Reflections on Returning Preclinical Alzheimer's Biomarker Results to Research Participants. J Prev Alzheimers Dis 2024; 11:1-6. [PMID: 38230711 PMCID: PMC10794852 DOI: 10.14283/jpad.2023.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Disclosing Alzheimer's disease (AD) biomarkers to research participants is a growing practice. Here, we aim to synthesize the experiences of clinicians leading preclinical AD biomarker disclosure. Semi-structured interviews were conducted individually with each of the four clinicians conducting biomarker disclosure as a part of a longitudinal, observational AD cohort study. Study clinicians emphasized the importance of participant education, having adequate time available for the disclosure visit, and forms to facilitate disclosure. To train and support future clinicians conducting AD biomarker disclosure, our study clinicians highlighted providing information about AD and biomarkers, shadowing a disclosure visit, having team debriefing sessions, and collating a frequently asked questions document. To date, this is the first characterization of clinician reflections on disclosing AD biomarker result to cognitively unimpaired research participants. As more clinicians in research or clinical settings seek to disclose AD biomarker results, best practices for training clinicians to lead disclosure are necessary.
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Affiliation(s)
- C M Erickson
- Lindsay Clark, PhD, Clinical Science Center, 600 Highland Ave. J5/1 Mezzanine, Madison, WI 53792, USA,
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12
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Linden I, Perry M, Wolfs C, Schers H, Dirksen C, Ponds R. Exploring diagnostic strategies for memory complaints in older adults: A retrospective general practice database study. Int J Geriatr Psychiatry 2024; 39:e6050. [PMID: 38175176 DOI: 10.1002/gps.6050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES For older people who worry about their memory, their general practitioner (GP) is often the first healthcare professional they turn to. This study aims to increase knowledge of GPs' daily practice on diagnostic strategies for patients who present themselves with memory complaints and/or worries about dementia for the first time in general practice and to explore associations of patients' characteristics with these strategies. METHOD Retrospective observational study using electronic patient records from patients presenting with memory complaints between 2012 and 2019. The patient records are derived from a Dutch primary care registration network. The decision on diagnostic strategy was extracted and categorized as (1) wait and see, (2) diagnostic testing in primary care, or (3) referral. Patient characteristics (gender, age, general practice, level of comorbidities, chronic polypharmacy, and the number of consultations on memory complaints), fear of developing dementia, and information on why the first consultation on memory complaints was scheduled were extracted. RESULTS A total of 228 patients were included. Most patients were cared for within primary care, either for further primary care diagnostics (56.1%) or because a wait-and-see strategy was pursued (14.9%). One-third (28.9%) of patients were referred. Differences between diagnostic strategies in patient characteristics, fear of developing dementia, or reason for first consultation between these diagnostic strategies were not found, nor were these variables predictive of referral. CONCLUSION Most Dutch patients with memory complaints and/or worries about dementia who seek help from their GP for the first time are cared for in the primary care setting for the following 6 months. The lack of association between included patient characteristics and diagnostic strategies highlights the complexity of the decision-making process on diagnostic testing for dementia in general practice.
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Affiliation(s)
- Iris Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marieke Perry
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Henk Schers
- Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carmen Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rudolf Ponds
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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13
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Vesikansa A, Halminen O, Mehtälä J, Hörhammer I, Mikkola T, Ylisaukko-Oja T, Linna M. Early start of anti-dementia medication is associated with lower health and social care costs in Alzheimer´s patients: a Finnish nationwide register study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1421-1428. [PMID: 36449133 DOI: 10.1007/s10198-022-01553-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To evaluate the association between health and social care costs and early start of anti-dementia medication in a nationwide cohort of Finnish Alzheimer's disease (AD) patients. METHODS The cohort included 7454 Finnish AD patients who had their first AD diagnosis in 2012 and lived at home at the time of diagnosis. Data were collected retrospectively from the Finnish national health and social care registers. The primary outcome was 2-year cumulative direct costs after the incident AD diagnosis. The exploratory variable was early anti-dementia medication start (anti-dementia medication started within 3 months of the incident AD diagnosis). Sociodemographic variables, admission to 24-h care and care intensity level, as well as comorbidities were considered as adjusting variables. RESULTS Of all patients, 88.9% started AD medication within 3 months of diagnosis. The 2-year cumulative costs were €30,787 and €40,484 per patient for early and late starters, respectively. When adjusted for possible confounders, early start of anti-dementia medication was associated with 26.5% lower 2-year cumulative costs compared to late starters (relative cost 0.735; p < 0.001). CONCLUSIONS Early diagnosis and start of anti-dementia medication is important for managing the costs of increasing number of AD patients.
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Affiliation(s)
| | - Olli Halminen
- Aalto University/Health Care, Engineering, Management and architecture (HEMA), Espoo , Finland
| | - Juha Mehtälä
- MedEngine Oy, Eteläranta 14, 00130, Helsinki, Finland
| | - Iiris Hörhammer
- Aalto University/Health Care, Engineering, Management and architecture (HEMA), Espoo , Finland
| | | | - Tero Ylisaukko-Oja
- MedEngine Oy, Eteläranta 14, 00130, Helsinki, Finland
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Miika Linna
- Aalto University/Health Care, Engineering, Management and architecture (HEMA), Espoo , Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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14
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McConnell ML, Marshall EG, Stock D, Trenaman SC, Andrew MK. Is Dementia Related to a Longer Wait Time to be Assigned a New Primary Care Provider? An Analysis of the Nova Scotia Need a Family Practice Registry Derived from the PUPPY-Study. Can Geriatr J 2023; 26:502-510. [PMID: 38045885 PMCID: PMC10684307 DOI: 10.5770/cgj.26.681] [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: 12/05/2023] Open
Abstract
Background Access to Primary Care Providers (PCPs) is limited for many Canadians. "Unattached patients" are persons who do not have a PCP. Older adults living with dementia may face greater challenges seeking attachment. This study investigated whether older adults living with dementia experience differential wait times for PCPs compared to those without a diagnosis of dementia. Methods This was an observational descriptive study of the centralized wait-list data from the Nova Scotia (NS) Need a Family Practice Registry (NaFPR). Time on provider wait-list by dementia diagnosis and age were compared. Number of days on the registry across these measures was estimated. Multivariable proportional hazards regression was used to compare hazards of remaining on the registry over time. Results Unattached older adults living with dementia were on the NaFPR for less time compared to those without dementia (381.4 vs. 428.8 days, respectively). After adjusting for age, self-reported gender, comorbidity, rurality, income quintiles, and overall deprivation, older adults with dementia had a 1.13-fold (95% CI: 1.04-1.24) increase in the likelihood of leaving the NaFPR. Potential contributors to this small difference could be placement in Long Term Care (LTC) and subsequent facility PCP attachment. Conclusions Analysis of the NaFPR exhibited similarly time to PCP attachment despite a diagnosis of dementia. This represented an effective equality model of health care utilized in NS. Future studies should investigate whether an equity model with priority attachment for vulnerable patients would reduce hospitalization and LTC institutionalization.
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Affiliation(s)
- Miranda L. McConnell
- Primary Care Research Unit, Dalhousie Departments of Family Medicine, Dalhousie University, Halifax
| | - Emily Gard Marshall
- Primary Care Research Unit, Dalhousie Departments of Family Medicine, Dalhousie University, Halifax
| | - David Stock
- Primary Care Research Unit, Dalhousie Departments of Family Medicine, Dalhousie University, Halifax
| | - Shanna C. Trenaman
- Department of Medicine (College of Pharmacy), Dalhousie University, Halifax
| | - Melissa K. Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS
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15
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Kim S, Yoon H, Jang Y. Access to Primary Healthcare and Discussion of Memory Loss with a Healthcare Provider in Adults with Subjective Cognitive Decline: Does Race/Ethnicity Matter? Behav Sci (Basel) 2023; 13:955. [PMID: 37998701 PMCID: PMC10669110 DOI: 10.3390/bs13110955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
Because subjective cognitive decline (SCD) manifests before the clinical and irreversible onset of dementia, efforts to address SCD are imperative for the early identification and prevention of dementia. For people who actually experience SCD, having a usual source of care may be an important catalyst for addressing memory issues. This study investigates the relationship between having a usual source of care and the discussion of SCD with healthcare providers, while taking into account racial and ethnic differences. The pooled 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) from 47 states in the U.S. was used. The sample included 7900 individuals aged 50 and older who reported significant cognitive decline. Using logistic regression with state-level clustering, we found that those with a usual source of healthcare were almost twice as more likely to discuss memory loss with a healthcare provider. In order to test for the multiplicative effects, we included an interaction term between each race category and having a primary care provider (PCP). There was a significant interaction effect between Hispanic ethnicity and having a PCP (OR = 0.25, p < 0.05). While non-Hispanic respondents who had a PCP had a higher probability of discussing memory issues with a healthcare provider (42% vs. 25%), Hispanic respondents with a PCP were less likely to discuss their memory loss with a healthcare provider (36% vs. 49%). The study adds to the growing literature on the vital role of the primary care service in provision of service to those with cognitive decline, while revealing ethnic disparity in memory-loss-related communication with healthcare providers in a primary care setting.
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Affiliation(s)
- Seoyoun Kim
- Department of Sociology, Texas State University, San Marcos, TX 78666, USA;
| | - Hyunwoo Yoon
- Department of Social Welfare, Institute of Social Welfare, Kongju National University, Gongju-si 32588, Republic of Korea
| | - Yuri Jang
- Edward R. Roybal Institute on Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90007, USA;
- Department of Social Welfare, Ewha Womans University, Seoul 07985, Republic of Korea
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Dumas A, Destrebecq F, Esposito G, Suchonova D, Steen Frederiksen K. Rethinking the detection and diagnosis of Alzheimer's disease: Outcomes of a European Brain Council project. AGING BRAIN 2023; 4:100093. [PMID: 37692977 PMCID: PMC10483037 DOI: 10.1016/j.nbas.2023.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Alzheimer's disease (AD), the most common form of dementia, is a progressive and debilitating neurodegenerative condition which robs people of their memory, their independence, their relationships and, ultimately, their lives. It affects close to 7 million people in the European Union (EU) alone. The detection and diagnosis of AD relies on a system that remains focused on the late stage of the disease, despite a better understanding of the disease progression. Clinical practice and healthcare systems' readiness to detect, diagnose and treat the disease effectively are still lagging. The use of biomarkers (cerebrospinal fluid tests (CSF) and positron emission tomography scans (PET)), which are central to a diagnostic assessment for people with AD symptoms, as well as relevant diagnostic facilities are under-utilised. PET imaging is expensive and of limited availability, and CSF sampling may be considered invasive. The European Brain Council's 'Rethinking Alzheimer's disease: Detection and diagnosis' White Paper has looked at the barriers to early diagnosis and how the healthcare systems infrastructure for detection and diagnosis of AD need to be transformed in order for people with AD to benefit from innovative solutions once they become approved for use.
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Affiliation(s)
- Annette Dumas
- European Brain Council, Rue d’Egmont 11, B-1000 Brussels, Belgium
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17
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Kokorelias KM, Shiers-Hanley JE, Li Z, Hitzig SL. A Systematic Review on Navigation Programs for Persons Living With Dementia and Their Caregivers. THE GERONTOLOGIST 2023; 63:1341-1350. [PMID: 35439813 DOI: 10.1093/geront/gnac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES System navigation programs are becoming more available to meet the needs of patients with complex care needs. The aim of this review was to systematically assess the outcomes of navigation programs for persons with dementia and their family caregivers. RESEARCH DESIGN AND METHODS A systematic review methodology was employed. Ten databases were searched for all relevant articles published until October 30, 2021. English-language full-text articles were included if they focused on implemented navigation program(s) that primarily supported persons with dementia who were aged 50 or older. Methodological quality was assessed by 2 independent raters using the Physiotherapy Evidence Database Scale, the STrengthening the Reporting of OBservational studies in Epidemiology checklist, and the Mixed Methods Appraisal Tool. RESULTS Fourteen articles were included in the review. There was Level 1 evidence for the benefits of system navigation programs on delaying institutionalization, wherein benefits appeared to be specific to interventions that had an in-person component. There was Level 1 (n = 4) and Level 3 (n = 1) evidence on service use from time of diagnosis to continued management of dementia. Finally, Level 1 to Level 5 evidence indicated a number of benefits on caregiver outcomes. DISCUSSION AND IMPLICATIONS There is strong evidence on the benefits of system navigation for people with dementia on delaying institutionalization and caregiver outcomes, but outcomes across other domains (i.e., functional independence) are less clear, which may be due to the varied approaches within system navigation models of care.
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Affiliation(s)
- Kristina M Kokorelias
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Zoe Li
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Sander L Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy and Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Muwanguzi M, Obua C, Maling S, Wong W, Owokuhaisa J, Wakida EK. Barriers and facilitators to cognitive impairment screening among older adults with diabetes mellitus and hypertension by primary healthcare providers in rural Uganda. FRONTIERS IN HEALTH SERVICES 2023; 3:1172943. [PMID: 37323226 PMCID: PMC10266276 DOI: 10.3389/frhs.2023.1172943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023]
Abstract
Background The burden of non-communicable diseases and cognitive impairment exhibit a linear rise in sub-Saharan Africa due to the increase in life expectancy. Non-communicable diseases like diabetes mellitus and hypertension increase the risk for cognitive impairment. To improve our understanding of the underpinnings of the cognitive impairment screening, this study explored the barriers and facilitators of routine cognitive impairment screening in a primary healthcare setting guided by the Capacity, Opportunity, Motivation Behavioral change (COM-B) model. Methods This was a descriptive qualitative study with primary healthcare providers who provide care to older adults with diabetes mellitus and hypertension at three primary healthcare centers in Mbarara district southwestern Uganda. In-depth interviews were conducted using a semi structured interview guide. Interviews were audio-recorded, transcribed verbatim, and analyzed using the framework approach along the COM-B components. Each COM-B component factors were categorized as barriers and facilitators. Results We conducted 20 in-depth interviews with clinical officers, enrolled nurses, and a psychiatric nurse. The questions were guided by the Capacity, Opportunity and Motivation Behavioral change (COM-B) framework to identify barriers and facilitators to cognitive impairment screening. The factors that negatively affected the screening were considered as barriers, while the positive as facilitators. Capacity related barriers to cognitive impairment screening included chronic understaffing, primary healthcare provider non-involvement, lack of training/skills, lack of knowledge and awareness in screening, absence of caretakers, lack of patient awareness of cognitive problems; while facilitators were staff recruitment, primary healthcare provider involvement, and specialized training. Opportunity related barriers to screening included patient overload, infrastructure shortage, and time constraints. Motivation related barriers included lack of screening guidance and policy, while the facilitators were availability of mentorship programs for primary healthcare providers. Conclusions Integrating cognitive impairment screening in primary health care requires engagement of relevant stakeholders with the focus on addressing implementation challenges through capacity development. Timely cognitive impairment screening at the first point of care initiates a cascade of interventions for timely enrollment into care, thus arresting the progress of cognitive impairment that leads to dementia.
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Affiliation(s)
- Moses Muwanguzi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Samuel Maling
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Wilson Wong
- Department of Medical Education, California University of Science and Medicine, Colton, CA, United States
| | - Judith Owokuhaisa
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edith K. Wakida
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medical Education, California University of Science and Medicine, Colton, CA, United States
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19
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Self-reported factors contributing to delay in ALS diagnosis among primary care providers in a large Ohio-based US healthcare network. J Neurol Sci 2023; 445:120532. [PMID: 36628902 DOI: 10.1016/j.jns.2022.120532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/08/2022] [Accepted: 12/20/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study's primary objective is to identify self-reported factors that contribute to diagnostic delay in ALS among Primary Care Providers (PCPs). METHODS A de novo email-based survey was deployed to Ohio-based PCPs in the Cleveland Clinic Health System. RESULTS Of the 77 PCP participants [including 30 Advance Practice Providers (APPs)] only: (a) 18% of physicians, and 3% of APPs were very confident or confident with recognizing signs and symptoms of ALS, (b) 13% of physicians, and 21% of APP s felt very confident or confident with distinguishing between a neurologic cause of dysfunction from other possible causes, and (c) 23% of physicians, and 11% of APPs felt very confident or confident with distinguishing between upper and lower motor neuron signs. If presented with a weak patient without a specific diagnosis, PCPs most frequently ordered electrodiagnostic testing, brain MRI, cervical or thoracic spine MRI, and serum creatine kinase. PCPs identified top reasons for delayed ALS diagnosis as: (a) patient's delay in seeking medical help, (b) diagnostic uncertainty (c) waiting time for neurology/neuromuscular medicine (NM) consultation. The most desired strategies to shorten diagnostic delay involved: (a) educating PCPs and other non-neurologist "gatekeeper" providers, (b) improving access to specialist neurology care, and (c) developing a reliable diagnostic test for ALS. DISCUSSION Self-reported factors that increase ALS diagnostic delay among PCPs primarily comprise gaps in clinical knowledge and skills required to detect key symptoms and signs, and suboptimal referral access to a neurology/NM provider. These areas represent important opportunities for targeted improvement efforts.
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20
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Gong N, Yang D, Zou J, He Q, Hu L, Chen W, Liao J. Exploring barriers to dementia screening and management services by general practitioners in China: a qualitative study using the COM-B model. BMC Geriatr 2023; 23:55. [PMID: 36717818 PMCID: PMC9886538 DOI: 10.1186/s12877-023-03756-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 01/16/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Dementia has become a global public health problem, and general practitioners (GPs) play a key role in diagnosing and managing dementia. However, in Chinese primary care settings, dementia is underdiagnosed and inefficiently managed, and dementia screening and management services provided by GPs are suboptimal. The reasons underlying this gap are poorly understood. This study aimed to determine the barriers that hinder GPs from actively promoting dementia screening and management, and thereby provide insights for the successful promotion of dementia screening and management services in primary care. METHODS Purposive sampling was used. And focus groups and in-depth interviews were conducted face-to-face among GPs from community health service centers (CHSCs) in South China. Thematic analysis was used to identify barriers to screening and managing dementia and map them to the Capability/Opportunity/Motivation-Behavior model (COM-B model). RESULTS Fifty-two GPs were included. The COM-B model found nine barriers to implementing dementia screening and management services in primary healthcare: (1) poor capability: lack of systematic knowledge of dementia and inadequate dementia screening skills; (2) little opportunity: unclear pathways for referral, insufficient time for dementia screening and management, lack of dementia-specific leaders, and no guarantee of services continuity; (3) low motivation: outside of GP scope, worries associated with dementia stigma rooted in culture beliefs, and insufficient financial incentives. CONCLUSIONS Our study concluded that GPs were not yet ready to provide dementia screening and management services due to poor capability related to knowledge and skills of dementia, little opportunity associated with an unsupportive working environment, and low motivation due to unclear duty and social pressure. Accordingly, systematic implementation strategies should be taken, including standardized dementia training programs, standardized community-based dementia guidelines, expansion of primary care workforces, development of dedicated leaders, and the eradication of stigma attached to dementia to promote dementia screening and management services in primary care.
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Affiliation(s)
- Ni Gong
- grid.258164.c0000 0004 1790 3548School of Nursing, Jinan University, Guangzhou, Guangdong, 510632 China
| | - Dan Yang
- grid.258164.c0000 0004 1790 3548School of Nursing, Jinan University, Guangzhou, Guangdong, 510632 China
| | - Jianfeng Zou
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou
, Guangdong, 510080 China ,Longhua District Chronic Disease Control Center, Longhua District, Shenzhen
, Guangdong, 518110 China
| | - Qianyu He
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou
, Guangdong, 510080 China ,grid.12981.330000 0001 2360 039XSun Yat-Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, Guangdong China
| | - Lei Hu
- grid.258164.c0000 0004 1790 3548School of Nursing, Jinan University, Guangzhou, Guangdong, 510632 China
| | - Weiju Chen
- grid.258164.c0000 0004 1790 3548School of Nursing, Jinan University, Guangzhou, Guangdong, 510632 China
| | - Jing Liao
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou
, Guangdong, 510080 China ,grid.12981.330000 0001 2360 039XSun Yat-Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, Guangdong China
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21
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Wollney EN, Armstrong MJ, Bedenfield N, Rosselli M, Curiel-Cid RE, Kitaigorodsky M, Levy X, Bylund CL. Barriers and Best Practices in Disclosing a Dementia Diagnosis: A Clinician Interview Study. Health Serv Insights 2022; 15:11786329221141829. [PMID: 36506598 PMCID: PMC9729996 DOI: 10.1177/11786329221141829] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
The vast majority of individuals with dementia want to receive a diagnosis. Research suggests, however, that only a fraction of individuals with dementia receive a diagnosis and patients and families often feel the information is poorly explained. We thus aimed to assess clinician-reported barriers to dementia disclosure and recommendations for giving a dementia diagnosis. To accomplish this, we performed telephone interviews with 15 clinicians from different specialties using a semi-structured interview guide. Transcripts were analyzed thematically. Clinician-reported barriers fit 3 categories: patient and caregiver-related barriers, clinician-related barriers, and barriers related to the triadic interaction. Patient and caregiver-related barriers included lack of social support, misunderstanding the diagnosis, and denial. Clinician barriers included difficulty giving bad news, difficulty communicating uncertainty, and lack of time. Triadic interaction barriers included challenges meeting multiple goals or needs and family requests for non-disclosure. Recommendations for best practice included for clinicians to foster relationships, educate patients and family, and take a family-centered approach. Clinicians described recommendations for fostering relationships such as using empathic communication and developing and maintaining connection. Educating patients and families included tailoring communication, explaining how the diagnosis was reached, and following up. Family approaches included meeting with family members prior to delivering the diagnosis and involving the caregiver in the discussion. Findings may inform updated recommendations for best practices when communicating a dementia diagnosis.
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Affiliation(s)
- Easton N Wollney
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA,Easton N Wollney, Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL 32610, USA.
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Noheli Bedenfield
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Monica Rosselli
- Department of Psychology, Florida Atlantic University, Davie, FL, USA
| | - Rosie E Curiel-Cid
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marcela Kitaigorodsky
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ximena Levy
- Clinical Research Unit, Division of Research, Florida Atlantic University, Boca Raton, FL, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
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22
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Sourial N, Schuster T, Bronskill SE, Godard-Sebillotte C, Etches J, Vedel I. Interprofessional Primary Care and Acute Care Hospital Use by People With Dementia: A Population-Based Study. Ann Fam Med 2022; 20:512-518. [PMID: 36443085 PMCID: PMC9705048 DOI: 10.1370/afm.2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Interprofessional primary care has the potential to optimize hospital use for acute care among people with dementia. We compared 1-year emergency department (ED) visits and hospitalizations among people with dementia enrolled in a practice having an interprofessional primary care team with those enrolled in a physician-only group practice. METHODS A population-based, repeated cohort study design was used to extract yearly cohorts of 95,323 community-dwelling people in Ontario, Canada, newly identified in administrative data with dementia between April 1, 2005 and March 31, 2015. Patient enrollment in an interprofessional practice or a physician-only practice was determined at the time of dementia diagnosis. We used propensity score-based inverse probability weighting to compare study groups on overall and nonurgent ED visits as well as on overall and potentially avoidable hospitalizations in the 1 year following dementia diagnosis. RESULTS People with dementia enrolled in a practice having an interprofessional primary care team were more likely to have ED visits (relative risk = 1.03; 95% CI, 1.01-1.05) and nonurgent ED visits (relative risk = 1.22; 95% CI, 1.18-1.28) compared with those enrolled in a physician-only primary care practice. There was no evidence of an association between interprofessional primary care and hospitalization outcomes. CONCLUSIONS Interprofessional primary care was associated with increased ED use but not hospitalizations among people newly identified as having dementia. Although interprofessional primary care may be well suited to manage the growing and complex dementia population, a better understanding of the optimal characteristics of team-based care and the reasons leading to acute care hospital use by people with dementia is needed.
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Affiliation(s)
- Nadia Sourial
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, Quebec, Canada .,University of Montreal Hospital Research Center, Montreal, Quebec, Canada
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada.,Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
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23
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Saposnik G, Ismail Z, Rivard AM, Knifton D, Bromfield G, Terzaghi M, Montoya A, Menard MC. Decision making under uncertainty in the diagnosis and management of Alzheimer's Disease in primary care: A study protocol applying concepts from neuroeconomics. Front Med (Lausanne) 2022; 9:997277. [DOI: 10.3389/fmed.2022.997277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe current management of patients with Dementia, primarily with Alzheimer's Disease (AD) is rapidly evolving. However, limited information is available about the current gaps and decision-making in primary care.ObjectivesTo evaluate factors associated with gaps, risk preferences regarding diagnostic and therapeutic choices in the management of patients with AD by primary care physicians (PCP) from across Canada.MethodsWe propose a non-interventional, cross-sectional pilot study involving 120 primary care physicians referred from the College of Family Physicians of Canada to assess diagnostic and therapeutic decisions in the management of ten simulated AD-related case-scenarios commonly encountered in clinical practice. We initially describe the current landscape and gaps regarding diagnostic and therapeutic challenges in the management of patients with AD in primary care. Then, we provide concepts from behavioral economics and neuroeconomics applied to medical decision-making. Specifically, we include standardized tests to measure risk aversion, physicians' reactions to uncertainty, and questions related to risk preferences in different domains. Finally, we summarize the protocol to be implemented to address our goals. The primary study outcome is the proportion of participants that elect to defer initial investigations to the specialist and the associated factors. Secondary outcomes include the proportion of PCP willing to order cerebral spinal fluid studies, PET scans, or initiate treatment according to the simulated case-scenarios. The study will be conducted in English and French.ConclusionsThe study findings will contribute a better understanding of relevant factors associated with diagnostic and therapeutic decisions of PCP in the management of AD, identifying participant's preferences and evaluating the role of behavioral aspects such tolerance to uncertainty, aversion to ambiguity, and therapeutic inertia.
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Reiss AB, de Levante Raphael D, Chin NA, Sinha V. The physician's Alzheimer's disease management guide: Early detection and diagnosis of cognitive impairment, Alzheimer's disease and related dementia. AIMS Public Health 2022; 9:661-689. [PMID: 36636148 PMCID: PMC9807411 DOI: 10.3934/publichealth.2022047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 01/16/2023] Open
Abstract
Primary care professionals play a critical role in the care of their patients. In clinical practice, early detection and diagnosis of Mild Cognitive Impairment, Alzheimer's disease and related dementia are often missed or delayed. Disclosure of diagnosis is not timely or not revealed. Though the methods that could improve early detection and diagnosis have remained the same over the decades with little change, they provide opportunities for early intervention, treatment and improvement in patient care. Emerging research suggests that though the disease process begins years prior to the clinical diagnosis, the healthcare system and health care professionals remain distant and reluctant to provide the service of annual cognitive assessment, which has been recommended by the Medicare program for older adults aged 65 years and older. Findings support that Alzheimer's disease and related cognitive impairments have gone under detected, underdiagnosed and undertreated. This article seeks to provide valuable and equitable information in the form of a clinician's guide for removing the barriers to early detection and diagnosis of cognitive impairments and offers an unprecedented opportunity to improve the clinical outcomes and care of older adults with various levels of cognitive decline, including mild cognitive impairment, Alzheimer's disease, and related dementias. This article provides information on understanding and addressing the challenges faced by health care professionals, including primary care clinicians; removing the barriers to cognitive assessments; educating this professional group on the importance of brain health, early detection, and diagnosis for their older adult patients; and providing these professionals with the ability to transfer their knowledge into more defined care planning. Until cognitive screening has been fully accepted and implemented for the optimal the care of older adults, health-related efforts should include the promotion and education of brain health, early detection, and diagnosis in the education of health care providers.
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Affiliation(s)
| | - Donna de Levante Raphael
- National Memory Screening Program, Alzheimer's Foundation of America, 322 Eighth Avenue, New York, NY 10001, USA
| | - Nathaniel A. Chin
- Wisconsin Alzheimer's Disease Research Center (ADRC), Madison, WI 53726
| | - Vivek Sinha
- Belleview Medical Partners, Alexandria, VA 22314 USA,* Correspondence: ; Tel: +19176888518; Fax: +16466381546
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25
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Lu Y, Liu C, Wells Y, Yu D. Challenges in detecting and managing mild cognitive impairment in primary care: a focus group study in Shanghai, China. BMJ Open 2022; 12:e062240. [PMID: 36127116 PMCID: PMC9490618 DOI: 10.1136/bmjopen-2022-062240] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Detection of mild cognitive impairment (MCI) is essential in slowing progression to dementia. Primary care plays a vital role in detecting and managing MCI. The chronic care model (CCM) provides effective methods to manage chronic diseases. OBJECTIVE This study aimed to explore how MCI services are delivered in primary care in China. METHODS Focus group interviews were conducted face to face among MCI stakeholders from six community health centres (CHCs) involved in the 'friendly community programme' in Shanghai, China. A total of 124 MCI stakeholders were interviewed, consisting of 6 groups (n=42) of general practitioners (GPs), 3 groups (n=18) of CHC managers, 4 groups (n=32) of people with MCI and 4 groups (n=32) of informal caregivers. Content and thematic analyses were performed using a combination of induction and deduction approaches. RESULTS Three major themes emerged from the data corresponding to the CCM framework: hesitant patients, unprepared providers and misaligned environments. While the public are hesitant to seek medical attention for MCI problems, due to misunderstanding, social stigma and a lack of perceived benefits, GPs and CHCs are not well prepared either, due to lack of knowledge and a shortage of GPs, and a lack of policy, funding and information support. None of these issues can be addressed separately without tackling the others. CONCLUSION This study combined the diverse perceptions of all the main stakeholders to detect and manage MCI in primary care settings in China. A vicious circle was found among the three interconnected CCM domains, creating a gridlock that should be addressed through a system's approach targeting all of the above-mentioned aspects.
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Affiliation(s)
- Yuan Lu
- Department of General Practice, Tongji University Affiliated Yangpu Hospital, Shanghai, China
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Yvonne Wells
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Dehua Yu
- Department of General Practice, Tongji University Affiliated Yangpu Hospital, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
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26
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Parker M, Barlow S, Hoe J, Aitken LM. The Bubble of Normalisation: A Qualitative Study of Carers of People With Dementia Who Do Not Seek Help for a Diagnosis. J Geriatr Psychiatry Neurol 2022; 35:717-732. [PMID: 34951319 PMCID: PMC9386763 DOI: 10.1177/08919887211060018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Improving dementia diagnosis rates are a key feature of dementia strategy and policy worldwide. This study aimed to explore the experience of carers of people diagnosed with dementia during or following a hospital admission in order to identify factors that had prevented them from seeking help beforehand. Semi-structured interviews were conducted with 12 informal carers including adults caring for a parent, a friend or a spouse diagnosed with dementia between 2010-2019, following an acute hospital admission for a physical health problem, having not sought help previously. MAIN FINDINGS Carers created a 'bubble of normalisation' around themselves and the person living with dementia (PLWD) to reject the label of dementia and protect the PLWD from a loss of independence, discrimination and prejudice they felt would be the result of a diagnosis. Carers struggled to talk to the PLWD about dementia reinforcing denial and stigma. Post-diagnosis carers felt unsupported and questioned the value of diagnosis. PRINCIPAL CONCLUSIONS Stigma related to images of dementia as a disease that takes away independence and identity prevented discussion about dementia between carers and the PLWD. A lack of open discussion about memory concerns between health care professionals and carers also served to delay diagnosis.
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Affiliation(s)
- Michelle Parker
- Division of Nursing, City University of London, London, UK,Michelle Parker, Division of Nursing, City University of London, Northampton Square, London EC1V 0HB, UK.
| | - Sally Barlow
- Division of Nursing, City University of London, London, UK
| | - Juanita Hoe
- Division of Nursing, City University of London, London, UK
| | - Leanne M. Aitken
- School of Health Sciences, City University of London, London, UK,School of Nursing & Midwifery, Griffith University, Australia
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27
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Sodri NI, Mohamed-Yassin MS, Mohamad M, Baharudin N. Confidence in Dementia Management and Its Associated Factors among Primary Care Doctors in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169995. [PMID: 36011637 PMCID: PMC9407797 DOI: 10.3390/ijerph19169995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 05/17/2023]
Abstract
Primary care doctors (PCDs) play an important role in the early diagnosis and management of dementia. This study aimed to determine the knowledge, attitude, and confidence in managing dementia among PCDs in Malaysia. It also aimed to determine the factors associated with higher confidence levels in dementia management. An online-based cross-sectional study using Google FormsTM was performed. Sociodemographic and work-related data were collected, and Dementia Knowledge among General Practitioners & General Practitioners Attitude and Confidence Scale for Dementia questionnaires were utilized to assess the knowledge, attitude, and confidence scores. Multiple linear regression was conducted to determine the association between sociodemographic factors, knowledge, and attitude with the confidence in dementia management score. A total of 239 PCDs participated, with the majority being female (72.4%) and Malay (64.4%) and working in public primary care clinics (67.4%). The mean (±SD) score for confidence was 2.96 (±0.76). Among the factors associated with higher confidence levels in managing dementia were higher dementia knowledge scores, higher attitude towards dementia scores, prior dementia education, and the availability of nearby referral services for dementia. Malaysian PCDs' confidence in dementia management was comparable to the PCDs of other countries. Strategies addressing these factors should be implemented to improve the confidence of PCDs in managing dementia.
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Affiliation(s)
- Nurul Izzah Sodri
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Batu Caves 68100, Selangor, Malaysia
| | - Mohamed-Syarif Mohamed-Yassin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Batu Caves 68100, Selangor, Malaysia
- Correspondence: ; Tel.: +60-3-6126-4655
| | - Mariam Mohamad
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, Sungai Buloh 47000, Selangor, Malaysia
| | - Noorhida Baharudin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Batu Caves 68100, Selangor, Malaysia
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de Levante Raphael D. The Knowledge and Attitudes of Primary Care and the Barriers to Early Detection and Diagnosis of Alzheimer’s Disease. Medicina (B Aires) 2022; 58:medicina58070906. [PMID: 35888625 PMCID: PMC9320284 DOI: 10.3390/medicina58070906] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/20/2022] Open
Abstract
Primary care physicians play a vital role in the clinical care of their patients, early identification of dementia, and disease advocacy. It is essential to assess the knowledge and attitudes of physicians in the diagnosis of Alzheimer’s disease and other dementias. In primary care, the diagnosis of Alzheimer’s disease is often missed or delayed. With the increased prevalence of Alzheimer’s disease and the growing impact of dementia on health care resources, early detection by primary care physicians (PCP) is essential. Thus, their knowledge and attitudes about early detection and diagnosis are crucial. To examine the knowledge and attitudes of primary care physicians regarding early detection and diagnosis of Alzheimer’s disease and how barriers may contribute to missed and delayed detection and diagnosis. An interpretive scope review was used to synthesize and analyze a body of literature published over the past decade. The study population are physicians in the United States. The current health systems experience challenges in providing early, safe, accurate, and comprehensive Alzheimer’s diagnosis and care by a primary care physician trained or knowledgeable in diagnosing the various forms of dementia. This article identifies several interrelated obstacles to early detection and diagnosis in primary dementia care, including gaps in knowledge, attitudes, skills, and resources for person with dementia (PWD)/caregivers and their primary care providers and systematic and structural barriers that negatively impact dementia care. Research shows that Alzheimer’s disease has gone underdiagnosed and undertreated. Delays in detection, diagnosis, and resource utilization may have social and clinical implications for individuals affected by Alzheimer’s disease and their families, including challenges in obtaining an accurate diagnosis. Until the issues of missed and delayed Alzheimer’s screening become more compelling, efforts to promote early detection and diagnosis should focus on the education of physicians and removing the barriers to diagnosis.
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Affiliation(s)
- Donna de Levante Raphael
- National Memory Screening Department, The Alzheimer's Foundation of America, New York, NY 10001, USA
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Birkeland RW, McCarron HR, Nkimberg M, Gaugler JE. Exploring Memory Care Clinics in Minnesota: A Qualitative Analysis. J Geriatr Psychiatry Neurol 2022; 35:601-612. [PMID: 34521279 DOI: 10.1177/08919887211044752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We explored memory clinic care provision in Minnesota, examining diversity and similarities of services provided and challenges faced. We also considered how well their services and care philosophies aligned with national dementia care practice recommendations. METHODS We created a 53-question interview guide and interviewed 11 memory clinics across Minnesota in late 2019. Interview transcripts were analyzed using Braun and Clarke's thematic analyses in NVivo 12. RESULTS We identified 6 themes regarding financial issues, staffing, appointment logistics, care provision during and after the memory evaluation as well as features of an ideal clinic. CONCLUSIONS Memory evaluation and care provision were very different across clinics, primarily due to team make-up, particularly team size and specialty. However, memory care providers shared a passion for providing patient-centered memory care, emphasizing family and patient education and partnership. Their care was largely aligned with national memory care recommendations. Common challenges, including maintaining financial stability and clinic efficiency, exerted significant influence on clinic functioning and survival.
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Affiliation(s)
- Robyn W Birkeland
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Hayley R McCarron
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Manka Nkimberg
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joseph E Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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30
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Linden I, Hevink M, Wolfs C, Perry M, Dirksen C, Ponds R. Understanding patients' and significant others' preferences on starting a diagnostic trajectory for dementia: An integrative review. Aging Ment Health 2022; 27:862-875. [PMID: 35763442 PMCID: PMC10166060 DOI: 10.1080/13607863.2022.2084505] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To explore the preferences of people with memory complaints (PwMC) and their significant others regarding starting a diagnostic trajectory for dementia. METHODS A systematic literature search was conducted in PubMed, PsycINFO, CINAHL, Web of Science, and Embase. Selection of abstracts and papers was performed independently by two researchers. Methodological quality was assessed with the Mixed Method Appraisal Tool. Result sections of the selected papers were thematically synthesized. RESULTS From 2497 citations, seven qualitative studies and two mixed methods studies published between 2010 and 2020 were included. Overall quality of the studies was high to moderate. A thematic synthesis showed that preferences for starting a diagnostic trajectory arose from the feeling of needing to do something about the symptoms, beliefs on the necessity and expected outcomes of starting a diagnostic trajectory. These views were influenced by normalization or validation of symptoms, the support or wishes of the social network, interactions with health care professionals, the health status of the PwMC, and societal factors such as stigma and socioeconomic status. CONCLUSION A variety of considerations with regard to decision-making on starting a diagnostic trajectory for dementia were identified. This emphasizes the need to explore individual preferences to facilitate a timely dementia diagnosis.
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Affiliation(s)
- Iris Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Maud Hevink
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marieke Perry
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Primary and Community care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carmen Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rudolf Ponds
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands.,Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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31
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Semere W, Cemballi AG, Schillinger D, Casillas A, Lemberg M, Lyles CR. "We need to bring them out from the shadows:" A qualitative study of safety net physician leaders' perspectives on caregivers. PATIENT EDUCATION AND COUNSELING 2022; 105:1663-1670. [PMID: 34756473 PMCID: PMC9033884 DOI: 10.1016/j.pec.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore physician leaders' perspectives on processes and priorities for engaging with caregivers in their clinical practices as well as within their safety net health systems. METHODS We conducted in-depth semi-structured interviews with primary care physicians in care management leadership at three California safety net health systems. Interviews explored physicians' experiences managing medically and socially complex patients with caregivers. Using thematic analysis, two qualitative researchers independently analyzed interview transcripts and established consensus with the broader research team through iterative input to derive major themes. RESULTS Fifteen physicians completed interviews. Nine participants were women, 8 were White and 10 reported Spanish language proficiency. Participant interviews generated six major themes: challenges uncovering caregiver identities, recognizing variation in caregivers' roles, adapting visit communication strategies to include caregivers, engaging caregivers in patient care, and caring for the caregiver. CONCLUSIONS Engaging caregivers is challenging given the limited recognition of caregiver involvement in patient care by health systems. Adapting visit communication to include caregivers requires bridging language and literacy barriers. PRACTICE IMPLICATIONS Developing mechanisms to enable the consistent identification of patients' caregivers, facilitate ongoing communication with caregivers, and extend support for them could improve outcomes for vulnerable patients and their families.
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Affiliation(s)
- Wagahta Semere
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA.
| | - Anupama G Cemballi
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | - Dean Schillinger
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Miya Lemberg
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | - Courtney R Lyles
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
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Clinician approaches to communicating a dementia diagnosis: An interview study. PLoS One 2022; 17:e0267161. [PMID: 35421205 PMCID: PMC9009687 DOI: 10.1371/journal.pone.0267161] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background Individuals with cognitive impairment and their families place a high value on receiving a dementia diagnosis, but clinician approaches vary. There is a need for research investigating experiences of giving and receiving dementia diagnoses. The current study aimed to investigate clinician approaches to giving dementia diagnoses as part of a larger study investigating patient, caregiver, and clinician experiences during the diagnosis encounter. Method Investigators conducted telephone interviews with Florida-based clinicians who give dementia diagnoses either rarely or commonly. Interviews employed a semi-structured interview guide querying communication practices used by clinicians when giving dementia diagnoses and how clinicians learned to give dementia diagnoses. Investigators used a descriptive qualitative design to conduct a thematic analysis of data. Results Fifteen Florida-based clinicians participated, representing diverse backgrounds related to gender, race/ethnicity, specialty, and practice setting. Participants reported using patient- and family-centered communication practices including checking patient understanding, communicating empathically, and involving family members. Some clinicians explicitly asked patients and/or family members about their preferences regarding diagnosis disclosure; many clinicians tailored their disclosure based on patient and family characteristics or reactions. Some clinicians reported using specific diagnoses, while others used general terms such as “memory disorder.” Clinicians reported positively framing information, including instilling hope, focusing on healthy behaviors, and discussing symptom management. Finally, clinicians provided patient/family education and arranged follow up. Clinicians reported learning approaches to dementia diagnosis disclosure through formal training and self-education. Conclusions Diverse Florida-based clinicians described dementia disclosure practices largely consistent with published guidance, but clinicians varied on approaches relating to soliciting patient disclosure preferences and terminology used. Clinicians caring for diverse populations described that cultural background affects the disclosure process, but more research is needed regarding this finding and best practices for individuals from different backgrounds.
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Lindauer A, Wild K, Natonson A, Mattek N, Wolf M, Steeves-Reece A, Messecar D. Dementia 360 ECHO: Using technology to facilitate diagnosis and treatment. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:202-208. [PMID: 33078687 PMCID: PMC8581834 DOI: 10.1080/02701960.2020.1835658] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dementia affects one in ten adults over age 65. Paradoxically, dementia (e.g., Alzheimer's disease and related dementias) is underdiagnosed, with approximately 50% of those with dementia lacking a formal diagnosis. This limits options for care, support and research engagement. To address this gap, we developed and implemented a telehealth-based ECHO (Extension for Community Healthcare Outcomes) program, "Dementia 360," to provide education and support for clinicians and allied team members. We assessed the feasibility and acceptability of this telementoring educational offering and the effect it had on clinician confidence in diagnosing and treating dementia. Clinicians from across Oregon (n = 67) attended learning sessions via videoconferencing technology. The sessions, which focused on dementia diagnosis and treatment, included didactic information provided by experts, followed by case discussions. We assessed clinician acceptability using surveys, and confidence in identifying and treating those with dementia prior to and after Dementia 360 using paired t tests. Dementia 360 was acceptable to clinicians and significantly increased their comfort levels in identifying and treating those with dementia. The technology-based program provided support and instruction that was acceptable by clinicians, even those in frontier areas of the state.
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Affiliation(s)
- Allison Lindauer
- Oregon Health & Science University, Oregon Alzheimer’s Disease Research Center, Portland, Oregon
- Oregon Health & Science University, School of Nursing
| | - Katherine Wild
- Oregon Health & Science University, Oregon Alzheimer’s Disease Research Center, Portland, Oregon
| | - Andrew Natonson
- Oregon Health & Science University, Oregon Alzheimer’s Disease Research Center, Portland, Oregon
| | - Nora Mattek
- Oregon Health & Science University, Oregon Alzheimer’s Disease Research Center, Portland, Oregon
| | - Miriam Wolf
- Oregon Health & Science University, Oregon ECHO Network
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Dementia and primary care teams: obstacles to the implementation of Portugal's Dementia Strategy. Prim Health Care Res Dev 2022; 23:e10. [PMID: 35177149 PMCID: PMC8919178 DOI: 10.1017/s1463423621000876] [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: 11/23/2022] Open
Abstract
Background: Portugal has a Dementia Strategy that endorses care coordination in the community, but the strategy is not implemented despite there being a network of multidisciplinary primary care clinics that could support it. Recent research into barriers to dementia management in primary care has focused essentially on general practitioners’ (GPs) factors and perspectives. A comprehensive triangulated view on the barriers to dementia management emphasising teamwork is missing. Aim: To explore the barriers to the implementation of the Portuguese Dementia Strategy by primary care teams, from the perspectives of service users and professionals. Methods: Purposive sampling was used to recruit 10 GPs, 8 practice nurses, 4 social workers, 8 people with dementia and 10 family carers from 6 practices in different social contexts within the Lisbon metropolitan area. The analytical framework combined codes derived from the transcripts with codes from the available literature. Themes focused on the access to professionals/community services, care coordination within healthcare teams, and between health and community services. Findings: Several system barriers were identified (undefined roles/coordination within teams, time constraints, insufficient signposting to community services) along with individual barriers (limited competence in dementia, unrecognised autonomy, limited views on social health and quality of life (QoL)), hindering users access to dementia services. Conclusion: Enhanced competence in dementia, and nurse-led systematic care of people with dementia and their carers, are necessary. They can be effective in improving the QoL in dementia, but only if associated with better community support.
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Factors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members. BMC Health Serv Res 2022; 22:148. [PMID: 35120516 PMCID: PMC8814777 DOI: 10.1186/s12913-022-07550-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 01/24/2022] [Indexed: 12/03/2022] Open
Abstract
Background The aging of rural populations contributes to growing numbers of people with dementia in rural areas. Despite the key role of primary healthcare in rural settings there is limited research on effective models for dementia care, or evidence on sustaining and scaling them. The purpose of this study was to identify factors influencing sustainability and scale-up of rural primary care based memory clinics from the perspective of healthcare providers involved in their design and delivery. Methods Participants were members of four interdisciplinary rural memory clinic teams in the Canadian province of Saskatchewan. A qualitative cross-sectional and retrospective study design was conducted. Data were collected via 6 focus groups (n = 40) and 16 workgroup meetings held with teams over 1 year post-implementation (n = 100). An inductive thematic analysis was used to identify themes. Results Eleven themes were identified (five that influenced both sustainability and scale-up, three related to sustainability, and three related to scale-up), encompassing team, organizational, and intervention-based factors. Factors that influenced both sustainability and scale-up were positive outcomes for patients and families, access to well-developed clinic processes and tools, a confident clinic leader-champion, facilitation by local facilitators and the researchers, and organizational and leadership support. Study findings revealed the importance of particular factors in the rural context, including facilitation to support team activities, a proven ready-to-use model, continuity of team members, and mentoring. Conclusions Interdisciplinary models of dementia care are feasible in rural settings if the right conditions and supports are maintained. Team-based factors were key to sustaining and scaling the innovation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07550-0.
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Bandini JI, Schulson LB, Ahluwalia SC, Harrison J, Chen EK, Lai JS, Edelen M. Patient, Family Caregiver, and Provider Perceptions on Self-Assessment Screening for Cognitive Impairment in Primary Care: Findings From a Qualitative Study. Gerontol Geriatr Med 2022; 8:23337214221131403. [PMID: 36275410 PMCID: PMC9583195 DOI: 10.1177/23337214221131403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/26/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to evaluate patient, family, and provider perspectives on routine cognitive screening of older adults in primary care using a novel self-assessment tool for detection of early cognitive impairment (CI). We conducted four virtual focus groups with patients aged 65 and older with no CI (n = 18) and family caregivers of patients with CI (n = 5) and interviews with primary care providers (n = 11). Patient and family caregiver participants felt that early detection of CI was important in primary care and may facilitate planning for the future including finances, living arrangements, and advance care planning. Providers reported that they do not use a standardized tool to routinely screen patients for CI yet endorsed the use of a self-assessment CI screening tool. These results suggest that routine screening of older adults using a brief, self-assessment screening tool for CI in primary care may be acceptable to patients, family caregivers, and providers. The findings from this study will inform the development of a brief self-assessment CI screening tool for use in primary care.
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Affiliation(s)
| | - Lucy B. Schulson
- RAND Corporation, Boston, MA, USA
- Boston University School of Medicine,
MA, USA
| | | | | | | | - Jin-Shei Lai
- Northwestern University Feinberg School
of Medicine, Chicago, IL, USA
| | - Maria Edelen
- RAND Corporation, Boston, MA, USA
- Brigham and Women’s Hospital, Boston,
MA, USA
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Rahman M, Mim SA, Islam R, Parvez A, Islam F, Uddin MB, Rahaman S, Shuvo PA, Ahmed M, Greig NH, Kamal MA. Exploring the Recent Trends in Management of Dementia and Frailty: Focus on Diagnosis and Treatment. Curr Med Chem 2022; 29:5289-5314. [PMID: 35400321 PMCID: PMC10477961 DOI: 10.2174/0929867329666220408102051] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/19/2021] [Accepted: 09/19/2021] [Indexed: 02/08/2023]
Abstract
Dementia and frailty increase health adversities in older adults, which are topics of growing research interest. Frailty is considered to correspond to a biological syndrome associated with age. Frail patients may ultimately develop multiple dysfunctions across several systems, including stroke, transient ischemic attack, vascular dementia, Parkinson's disease, Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies, cortico-basal degeneration, multiple system atrophy, amyotrophic lateral sclerosis, and Creutzfeldt-Jakob disease. Patients with dementia and frailty often develop malnutrition and weight loss. Rigorous nutritional, pharmacological, and non-pharmacological interventions generally are required for these patients, which is a challenging issue for healthcare providers. A healthy diet and lifestyle instigated at an early age can reduce the risk of frailty and dementia. For optimal treatment, accurate diagnosis involving clinical evaluation, cognitive screening, essential laboratory evaluation, structural imaging, functional neuroimaging, and neuropsychological testing is necessary. Diagnosis procedures best apply the clinical diagnosis, identifying the cause(s) and the condition(s) appropriate for treatment. The patient's history, caregiver's interview, physical examination, cognitive evaluation, laboratory tests, and structural imaging should best be involved in the diagnostic process. Varying types of physical exercise can aid the treatment of these disorders. Nutrition maintenance is a particularly significant factor, such as exceptionally high-calorie dietary supplements and a Mediterranean diet to support weight gain. The core purpose of this article is to investigate trends in the management of dementia and frailty, focusing on improving diagnosis and treatment. Substantial evidence builds the consensus that a combination of balanced nutrition and good physical activity is an integral part of treatment. Notably, more evidence-based medicine knowledge is required.
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Affiliation(s)
- Mominur Rahman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Sadia Afsana Mim
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Rezaul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Anwar Parvez
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Fahadul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Mohammad Borhan Uddin
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Saidur Rahaman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Pollob Ahmed Shuvo
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Muniruddin Ahmed
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Nigel H. Greig
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Mohammad Amjad Kamal
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- King Fahd Medical Research Center, King Abdulaziz University, Saudi Arabia
- Enzymoics, NSW; Novel Global Community Educational Foundation, Peterlee Place, Hebersham, NSW 2770, Australia
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Wheatley A, Bamford C, Brunskill G, Booi L, Dening KH, Robinson L. Implementing post-diagnostic support for people living with dementia in England: a qualitative study of barriers and strategies used to address these in practice. Age Ageing 2021; 50:2230-2237. [PMID: 34240114 PMCID: PMC8675435 DOI: 10.1093/ageing/afab114] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND inequalities and gaps in post-diagnostic support (PDS) for people with dementia persist despite a policy focus on dementia in England and Wales. Understanding and overcoming the factors contributing to these inequalities is vital to improve care for people living with dementia (PLWD) and their families. OBJECTIVE to explore common barriers to the delivery of PDS in England and Wales and describe successful strategies to address them, drawing on examples from current practice. DESIGN qualitative semi-structured interviews, focus groups and observation. SETTINGS Phase 1: interviewees were drawn from multiple sectors across England and Wales, including NHS clinical commissioning groups and social care. Phase 2: six case study sites based in different sectors (primary care, secondary mental health and third sector) in England. PARTICIPANTS Phase 1: 61 professionals, including commissioners and service managers. Phase 2: 68 professionals, including frontline staff and those working in related services; 17 PLWD; 31 carers. RESULTS barriers to implementing PDS in dementia were an unsupportive infrastructure, limited proactive review and limited capacity and capability particularly in primary care. Strategies used successfully in practice to address these challenges included creating opportunities for service development, improving joint working, supporting non-specialists and developing ongoing, holistic review and care planning. CONCLUSION a range of practical strategies have been identified to address many of the common barriers to PDS in dementia. To achieve policy goals of a task-shifted and task-shared approach to PDS, widespread use of these strategies is recommended.
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Affiliation(s)
- Alison Wheatley
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Brunskill
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Booi
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Harrison Dening
- Health & Life Sciences, School of Nursing and Midwifery, De Montfort University, Leicester, UK
- Research & Publications, Dementia UK, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Leon T, Castro L, Mascayano F, Lawlor B, Slachevsky A. Evaluating a Memory Clinic Using the RE-AIM Model. The Experience of the "Memory and Neuropsychiatry Clinic" in Hospital Del Salvador, Chile. Front Neurol 2021; 12:612416. [PMID: 34552545 PMCID: PMC8451412 DOI: 10.3389/fneur.2021.612416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 07/30/2021] [Indexed: 12/25/2022] Open
Abstract
The development of healthcare services for dementia is key to improving access to care and post-diagnostic support for people living with dementia. Memory Units have emerged as a new healthcare service composed of multidisciplinary teams with the goal of improving diagnosis and/or management of dementia patients. The main objective of this study was to describe and evaluate the Reach and Effectiveness of a Memory Unit in a public hospital in Chile, using the RE-AIM model, a multi-component model that allows for the evaluation of the implementation of ongoing healthcare programs. Regarding “R” (Reach): from March 2018 up to June 2019, a total of 510 patients were referred and assessed. Most patients came from primary care (51.9%) and from outpatient services at the Hospital Salvador (39.2%), particularly from the Neurology (63.3%) and Psychiatry (16.0%) departments. We estimated that our Memory Unit assessed 5.39% of all of the dementia patients living in the area of referral. With respect to “E” (Effectiveness): 419 patients are still being followed up at the Memory Unit. Ninety-one patients (18%) were discharged. Of these, 55 (66%) were referred to primary healthcare, 28 (31%) to other outpatient services, 9 (10%) to a specialized mental healthcare center, and 9 (10%) to a daycare center. Due to the short period of time that the Memory Unit has been operating, no other RE-AIM dimensions could be evaluated at this juncture. To our knowledge, this is the first implementation study of a Memory Unit in Latin America, and the first using the RE-AIM model. Although cultural differences worldwide might play a role in the lack of international guidelines, the publication of the experience of the first year of this unit in Chile could inform new countries about this process. Ongoing challenges include continuing to collect data to complement the RE-AIM evaluation and developing a protocol that can be adopted elsewhere in Chile and Latin America. Further studies are needed to assess the benefits of a Memory Unit in comparison to regular care and to develop a model that assures continuity and coordination of care for people with dementia.
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Affiliation(s)
- Tomas Leon
- Memory and Neuropsychiatric Clinic, Neurology Department, Del Salvador Hospital and University of Chile School of Medicine, Santiago, Chile.,Department of Psychiatry and Global Brain Health Institute, Trinity College, Dublin, Ireland
| | - Loreto Castro
- Memory and Neuropsychiatric Clinic, Neurology Department, Del Salvador Hospital and University of Chile School of Medicine, Santiago, Chile
| | - Franco Mascayano
- Mailman School of Public Health, Columbia University, New York, NY, United States.,Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Brian Lawlor
- Department of Psychiatry and Global Brain Health Institute, Trinity College, Dublin, Ireland
| | - Andrea Slachevsky
- Memory and Neuropsychiatric Clinic, Neurology Department, Del Salvador Hospital and University of Chile School of Medicine, Santiago, Chile.,Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile.,Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department, Instituto de Ciencias Biomedicas (ICBM), Neurosciences and East Campus Neuroscience Departments, University of Chile School of Medicine, Santiago, Chile.,Neurology Unit, Department of Medicine, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
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Perrault-Sequeira L, Torti J, Appleton A, Mathews M, Goldszmidt M. Discharging the complex patient - changing our focus to patients' networks of care providers. BMC Health Serv Res 2021; 21:950. [PMID: 34507571 PMCID: PMC8431846 DOI: 10.1186/s12913-021-06841-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background A disconnect exists between the idealized model of every patient having a family physician (FP) who acts as the central hub for care, and the reality of health care where patients must navigate a network of different providers. This disconnect is particularly evident when hospitalized multimorbid patients transition back into the community. These discharges are identified as high-risk due to lapses in care continuity. The aim of this study was to identify and explore the networks of care providers in a sample of hospitalized, complex patients, and better understand the nature of their attachments to these providers as a means of discovering novel approaches for improving discharge planning. Methods This was a constructivist grounded theory study. Data included interviews from 30 patients admitted to an inpatient internal medicine service of a midsized academic hospital in Ontario, Canada. Analysis and data collection proceeded iteratively with sampling progressing from purposive to theoretical. Results We identified network of care configurations commonly found in patients with multiple medical comorbidities receiving care from multiple different providers admitted to an internal medicine service. FPs and specialists form the network’s scaffold. The involvement of physicians in the network dictated not only how patients experienced transitions in care but the degree of reliance on social supports and personal capacities. The ideal for the multimorbid patient is an optimally involved FP that remains at the centre, even when patients require more subspecialized care. However, in cases where a rostered FP is non-existent or inadequate, increased involvement and advocacy from specialists is crucial. Conclusions Our results have implications for transition planning in hospitalized complex patients. Recognizing salient network features can help identify patients who would benefit from enhanced discharge support. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06841-2.
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Affiliation(s)
| | - Jacqueline Torti
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Centre for Education Research & Innovation - Western University, London, ON, Canada
| | - Andrew Appleton
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Maria Mathews
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Mark Goldszmidt
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Centre for Education Research & Innovation - Western University, London, ON, Canada
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Lv X, Zhao M, Li T, Yuan C, Zhang H, Pu C, Li Z, Zhang N, Yu X, Wang H. Effects of an Enhanced Training on Primary Care Providers Knowledge, Attitudes, Service and Skills of Dementia Detection: A Cluster Randomized Trial. Front Neurol 2021; 12:651826. [PMID: 34367045 PMCID: PMC8342805 DOI: 10.3389/fneur.2021.651826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Effective training programs for primary care providers (PCPs) to support dementia detection are needed, especially in developing countries. This study aimed to investigate the effect of an enhanced training on the competency and service of PCPs for dementia detection. Methods: We conducted a cluster randomized trial in Beijing, China. Community healthcare centers (CHCs) located in Fengtai or Fangshan District were eligible. The enrolled CHCs in each district were randomly assigned to the standard or the enhanced training group at a 1:1 ratio. PCPs serving older adults in enrolled CHCs were eligible to participate. The standard training group received three-hour didactic lectures, three monthly supervisions, 3 months of online support and dementia screening packages. The enhanced training group additionally received three monthly face-to-face supervisions and 3 months of online support. The participants became aware of their group membership at the end of the standard training. The knowledge, attitudes, service, and skills regarding dementia detection were assessed using questionnaires and submitted dementia detection records, respectively. Results: A total of 23 and 21 CHCs were randomly assigned to the standard and the enhanced training group, respectively, and 58 participants from 20 CHCs assigned to the standard training group and 48 from 16 CHCs assigned to the enhanced training group were included in the final analysis (mean age 37.5 years, and 67.0% women). A significant increase in the knowledge score was found in both groups, but the increase was similar in the two groups (P = 0.262). The attitude score remained stable in both groups, and no between-group difference was found. Compared with the baseline, both groups reported an increase in dementia detection service, especially the enhanced training group (24.1% to 31.0% in the standard training group and 14.6% to 45.8% in the enhanced training group). The completion rate and accuracy of submitted dementia detection records in the enhanced training group were both significantly higher than those in the standard training group (both P < 0.001). Conclusion: The enhanced training had similar effect on the knowledge of PCPs comparing with the standard training, but was better on continuous service and skills of PCPs related to dementia detection. Trial registration:www.ClinicalTrials.gov, identifier: NCT02782000. Registration date: May 2016. The trial was completed in July 2017.
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Affiliation(s)
- Xiaozhen Lv
- Beijing Dementia Key Lab, Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Mei Zhao
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Tao Li
- Beijing Dementia Key Lab, Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Changzheng Yuan
- Department of Big Data in Health Science, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Haifeng Zhang
- Beijing Dementia Key Lab, Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Chengcheng Pu
- Beijing Dementia Key Lab, Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Zhiying Li
- Beijing Dementia Key Lab, Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Na Zhang
- Psychological Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Yu
- Beijing Dementia Key Lab, Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Huali Wang
- Beijing Dementia Key Lab, Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, China
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Gibson C, Goeman D, Hutchinson A, Yates M, Pond D. The provision of dementia care in general practice: practice nurse perceptions of their role. BMC FAMILY PRACTICE 2021; 22:110. [PMID: 34107867 PMCID: PMC8191039 DOI: 10.1186/s12875-021-01467-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
Background Primary care nurses can assist General Practitioner’s to identify cognition concerns and support patient health self-management for those experiencing cognitive impairment or dementia. This support may lead to more appropriate care and better health outcomes for this group. Consequently, there is a need to identify the role of the primary care nurse in dementia care provision, nurse perceptions of this role and to also understand the barriers and enablers that may influence any current or potential primary care nurse role in dementia care provision. Methods Eight focus groups were conducted with a total of 36 primary care nurses. Data was transcribed verbatim and thematically analysed. Results There was a high level of agreement between primary care nurses that they had a role in provision of dementia care. This role was largely attributed to the strong therapeutic relationship between nurses and patients. However, dementia care provision was not without its challenges, including a perceived lack of knowledge, limited resources and the hierarchical nature of general practice. Three main themes were identified: personal attributes of the primary care nurse; professional attributes of the primary care nurse role and the context of practice. Six sub-themes were identified: knowing the person; overcoming stigma; providing holistic care; knowing what to do; team culture and working in the system. Conclusions The findings of this study suggest primary care nurses have a role in dementia care provision and, there is a need to provide support for the nurse to deliver person-centred health care in the context of cognitive impairment. As the demand for good quality primary care for people living with dementia increases, the role of the primary care nurse should be considered in primary care policy discussions. The knowledge gained from this study could be useful in informing dementia training content, to provide better prompts in the health assessment and care planning templates used by primary care nurses to better identify the care needs of people with a cognitive impairment and to develop dementia care guidelines for primary care nurses.
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Affiliation(s)
- Caroline Gibson
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Melbourne, Australia.
| | - Dianne Goeman
- Faculty of Health and Medicine, School of Medicine and Public Health, Central Clinical School, University of Newcastle, Monash University, Melbourne, Australia
| | - Alison Hutchinson
- School of Nursing and Midwifery, Monash HealthCentre for Quality and Patient Safety ResearchInstitute for Health Transformation, Deakin University, Melbourne, Australia
| | - Mark Yates
- Deakin University School of Medicine, Ballarat Health Services, Melbourne, Australia
| | - Dimity Pond
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Melbourne, Australia
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Gibson C, Goeman D, Yates MW, Pond D. Clinical practice guidelines and principles of care for people with dementia: a protocol for undertaking a Delphi technique to identify the recommendations relevant to primary care nurses in the delivery of person-centred dementia care. BMJ Open 2021; 11:e044843. [PMID: 33986053 PMCID: PMC8126272 DOI: 10.1136/bmjopen-2020-044843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Nationally and internationally it is well recognised that dementia is poorly recognised and suboptimally managed in the primary care setting. There are multiple and complex reasons for this gap in care, including a lack of knowledge, high care demands and inadequate time for the general practitioner alone to manage dementia with its multiple physical, psychological and social dimensions. The primary care nurse potentially has a role in assisting the general practitioner in the provision of evidence-based dementia care. Although dementia-care guidelines for general practitioners exist, evidence on resources to support the primary care nurse in dementia care provision is scarce. The 'Australian Clinical Practice Guidelines and Principles of Care for People with Dementia' provides 109 recommendations for the diagnosis and management of dementia. This protocol describes a Delphi study to identify which of the 109 recommendations contained in these multidisciplinary guidelines are relevant to the primary care nurse in the delivery of person-centred dementia care in the general practice setting. METHODS AND ANALYSIS Using a Delphi consensus online survey, an expert panel will grade each of the recommendations written in the 'Clinical Practice Guidelines and Principles of Care for People with Dementia' as high-to-low relevance with respect to the role of the primary care nurse in general practice. To optimise reliability of results, quality indicators will be used in the data collection and reporting of the study. Invited panel members will include Australian primary care nurses working in general practice, primary care nursing researchers and representatives of the Australian Primary Health Care Nurses Association, the peak professional body for nurses working in primary healthcare. ETHICS AND DISSEMINATION This study has been approved by The University of Newcastle Human Research Ethics Committee (HREC) (H-2019-0029).Findings will be published in a peer-reviewed journal and presented at scientific conferences.
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Affiliation(s)
- Caroline Gibson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Dianne Goeman
- Department of Public Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
- Department of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mark William Yates
- Geriatric Medicine, Ballarat Health Service, Ballarat, Victoria, Australia
- Ballarat Clinical School, Deakin University, Ballarat, Victoria, Australia
| | - Dimity Pond
- General Practice, University of Newcastle Australia, Callaghan, New South Wales, Australia
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Bablok I, Binder H, Stelzer D, Kaier K, Graf E, Wangler J, Jansky M, Löhr M, Schulz M, Kockläuner M, Geschke K, Wuttke-Linnemann A, Fellgiebel A, Farin E. Primary dementia care based on the individual needs of the patient: study protocol of the cluster randomized controlled trial, DemStepCare. BMC Geriatr 2021; 21:222. [PMID: 33794789 PMCID: PMC8012747 DOI: 10.1186/s12877-021-02114-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/24/2021] [Indexed: 11/27/2022] Open
Abstract
Background Most people with dementia (PwD) are cared for at home, with general practitioners (GPs) playing a key part in the treatment. However, primary dementia care suffers from a number of shortcomings: Often, diagnoses are made too late and therapies by GPs do not follow the guidelines. In cases of acute crises, PwD are too often admitted to hospital with adverse effects on the further course of the disease. The aim of this study is to implement and evaluate a new GP-based, complex dementia care model, DemStepCare. DemStepCare aims to ensure demand-oriented, stepped care for PwD and their caregivers. Methods/design In a cluster randomized controlled trial, the care of PwD receiving a complex intervention, where the GP is supported by a multi-professional team, is compared to (slightly expanded) usual care. GPs are clustered by GP practice, with 120 GP practices participating in total. GP practices are randomized to an intervention or a control group. 800 PwD are to be included per group. Recruitment takes place in Rhineland-Palatinate, Germany. In addition, a second control group with at least 800 PwD will be formed using aggregated routine data from German health insurance companies. The intervention comprises the training of GPs, case management including repeated risk assessment of the patients’ care situation, the demand-oriented service of an outpatient clinic, an electronic case record, external medication analyses and a link to regional support services. The primary aims of the intervention are to positively influence the quality of life for PwD, to reduce the caregivers’ burden, and to reduce the days spent in hospital. Secondary endpoints address medication adequacy and GPs’ attitudes and sensitivity towards dementia, among others. Discussion The GP-based dementia care model DemStepCare is intended to combine a number of promising interventions to provide a complex, stepped intervention that follows the individual needs of PwD and their caregivers. Its effectiveness and feasibility will be assessed in a formative and a summative evaluation. Trial registration German Register of Clinical Trials (Deutsches Register Klinischer Studien, DRKS), DRKS00023560. Registered 13 November 2020 - Retrospectively registered. HTML&TRIAL_ID=DRKS00023560.
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Affiliation(s)
- Isabella Bablok
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Dominikus Stelzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Erika Graf
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Julian Wangler
- Center for General and Geriatric Medicine, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Michael Jansky
- Center for General and Geriatric Medicine, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Michael Löhr
- Landschaftsverband Westfalen-Lippe, Hospital Gütersloh, Gütersloh, Germany.,Diakonie University of Applied Sciences, Bielefeld, Germany
| | - Michael Schulz
- Landschaftsverband Westfalen-Lippe, Hospital Gütersloh, Gütersloh, Germany.,Diakonie University of Applied Sciences, Bielefeld, Germany
| | - Marie Kockläuner
- Department of Pharmacy, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Katharina Geschke
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.,Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
| | - Alexandra Wuttke-Linnemann
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.,Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
| | - Andreas Fellgiebel
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.,Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
| | - Erik Farin
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Marr S, McKibbon K, Patel A, McKinnon Wilson J, Hillier LM. The geriatric certificate program: collaborative partnerships for building capacity for a competent workforce. GERONTOLOGY & GERIATRICS EDUCATION 2021; 42:13-23. [PMID: 30706766 DOI: 10.1080/02701960.2019.1572004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Many practicing health care providers find themselves ill-prepared to meet the complex care needs of older adults. The Geriatric Certificate Program (GCP) represents a collaborative partnership leveraging existing educational courses, with new courses developed to fill existing education gaps, aimed at improving quality of care for older adults. This paper describes the GCP and examines its impact on knowledge, skills, clinical practice, as well as confidence, comfort, and competence in providing geriatric care. Upon program completion, all graduates (N = 146; 100%) completed an online evaluation survey. The majority of graduates reported (5-point scale: 1 = much less now; 5 = much more now) being more confident (88%), comfortable (83%), and competent (89%) to provide optimal geriatric care than prior to the program. The GCP provides a significant opportunity for health care providers to build their capacity for the care of older adults. Key lessons learned in implementing the GCP and suggestions for further development are discussed.
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Affiliation(s)
- Sharon Marr
- Regional Geriatric Program central, Hamilton, Ontario, Canada
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kristy McKibbon
- Regional Geriatric Program central, Hamilton, Ontario, Canada
| | - Anisha Patel
- Regional Geriatric Program central, Hamilton, Ontario, Canada
| | | | - Loretta M Hillier
- Geriatric Education and Research in Aging Sciences (GERAS) Centre, Hamilton, Ontario, Canada
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Pond D, Higgins I, Mate K, Merl H, Mills D, McNeil K. Mobile memory clinic: implementing a nurse practitioner-led, collaborative dementia model of care within general practice. Aust J Prim Health 2021; 27:6-12. [PMID: 33517974 DOI: 10.1071/py20118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022]
Abstract
The limited capacity of secondary health services to address the increasing prevalence of dementia within the community draws attention to the need for an enhanced role for nurses working collaboratively with GPs in diagnosing and coordinating post-diagnostic care for patients with dementia. This study investigated the feasibility and acceptability of a nurse practitioner-led mobile memory clinic that was embedded within general practice and targeted to caring for patients and their carers in areas of socioeconomic disadvantage with poor access to specialist health services. Over the period from mid-2013 to mid-2014, 40 GPs referred 102 patients, with the nurse practitioner conducting assessments with 77 of these patients in their homes. Overall, there was a strong interest in this model of care by general practice staff, with the assessment and care provided by the nurse practitioner evaluated as highly acceptable by both patients and their carers. Nonetheless, there are financial and structural impediments to this model of care being implemented within the current Australian health service framework, necessitating further research investigating its cost-effectiveness and efficacy.
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Affiliation(s)
- Dimity Pond
- School of Medicine and Public Health, Office 134, The Building and Investment Centre of Excellence, University of Newcastle, 10 Chittaway Road, Ourimbah, NSW 2258, Australia; and Corresponding author.
| | - Isabel Higgins
- School of Nursing and Midwifery, RW227, Richardson Wing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Karen Mate
- School of Biomedical Sciences and Pharmacy, LS350, Life Sciences Building, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Helga Merl
- Hunter New England Local Health District and Hunter Medicare Local. Present address: Wicking Dementia Research and Education Centre, Room B128, University of Tasmania, Private Bag 143, Hobart, Tas. 7001, Australia
| | - Dianne Mills
- Aged Care and Rehabilitation Services (LMNCS), Hunter New England Health District, Building 2, Level 1, 26 York Street, Taree, NSW 2430, Australia
| | - Karen McNeil
- School of Medicine and Public Health, Office 134, The Building and Investment Centre of Excellence, University of Newcastle, 10 Chittaway Road, Ourimbah, NSW 2258, Australia
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Balsinha C, Iliffe S, Dias S, Freitas A, Grave J, Gonçalves-Pereira M. What is the present role for general practitioners in dementia care? Experiences of general practitioners, patients and family carers in Portugal. DEMENTIA 2020; 20:1988-2006. [PMID: 33342279 PMCID: PMC8358531 DOI: 10.1177/1471301220977710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Governments are being challenged to integrate at least part of dementia care into primary care. However, little is known about the current role of general practitioners (GPs) regarding dementia care, especially in countries that do not have dementia strategies in place. The aim of this study was to explore the experiences of GPs, persons with dementia and their family carers in Portuguese primary care settings, to better understand GPs’ contribution to dementia care. Methods A qualitative interview study of participants recruited from six practices in different social contexts within the Lisbon metropolitan area was carried out. Purposive sampling was used to recruit GPs, persons with dementia and carers. Interviews with GPs explored dementia care comprehensiveness, including satisfactory and challenging aspects. Interviews with patients and carers explored the experience of talking to GPs about cognitive impairments and related difficulties and the type of help received. Thematic analysis of interview transcripts was carried out using the framework approach. Results Five major themes were identified: GPs have a limited contribution to dementia care, the case of advanced dementia, doctor–patient relationships, doctor–carer relationships and management of chronic conditions other than dementia. Conclusion General practitioners seemed to contribute little to dementia care overall, particularly regarding symptom management. The exception was patients with advanced stages of dementia, given that specialists no longer followed them up. Remarkably, GPs seemed to be alone within primary care teams in providing dementia care. These findings strongly suggest that Portuguese primary care is not yet prepared to comply with policy expectations regarding the management of dementia.
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Affiliation(s)
- Conceição Balsinha
- Comprehensive Health Research Centre (CHRC); NOVA Medical School/Faculdade de Ciências Médicas, 50106Universidade Nova de Lisboa, Lisboa, Portugal; 428179Unidade de Saúde Familiar Marginal, São João do Estoril, Portugal
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Sónia Dias
- Comprehensive Health Research Centre (CHRC); NOVA National School of Public Health, Public Health Research Centre, 50106Universidade NOVA de Lisboa, Portugal
| | - Alexandre Freitas
- NOVA Medical School/Faculdade de Ciências Médicas, 50106Universidade Nova de Lisboa, Lisboa, Portugal; Unidade de Saúde Familiar Ilumina,São Domingos de Rana, Portugal
| | - Joana Grave
- NOVA Medical School/Faculdade de Ciências Médicas, 50106Universidade Nova de Lisboa, Lisboa, Portugal
| | - Manuel Gonçalves-Pereira
- Comprehensive Health Research Centre (CHRC); NOVA Medical School/Faculdade de Ciências Médicas, 50106Universidade Nova de Lisboa, Lisboa, Portugal
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Bacsu J, Mateen FJ, Johnson S, Viger MD, Hackett P. Improving Dementia Care Among Family Physicians: From Stigma to Evidence-Informed Knowledge. Can Geriatr J 2020; 23:340-343. [PMID: 33282053 PMCID: PMC7704071 DOI: 10.5770/cgj.23.426] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Juanita Bacsu
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK.,Saskatchewan Population Health and Evaluation Research Unit (SPHERU), University of Saskatchewan, Saskatoon, SK, Canada
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shanthi Johnson
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Marc D Viger
- Department of Family Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Paul Hackett
- Department of Geography, SPHERU, University of Saskatchewan, Saskatoon, SK Canada
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Ng NSQ, Ward SA. Diagnosis of dementia in Australia: a narrative review of services and models of care. AUST HEALTH REV 2020; 43:415-424. [PMID: 30049298 DOI: 10.1071/ah17167] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 03/23/2018] [Indexed: 12/28/2022]
Abstract
Objective There is an impetus for the timely diagnosis of dementia to enable optimal management of patients, carers and government resources. This is of growing importance in the setting of a rising prevalence of dementia in an aging population. The Australian Clinical Practice Guidelines and Principles of Care for People with Dementia advocate referral to comprehensive memory services for dementia diagnosis, but in practice many patients may be diagnosed in other settings. The aim of the present study was to obtain evidence of the roles, effectiveness, limitations and accessibility of current settings and services available for dementia diagnosis in Australia. Methods A literature review was performed by searching Ovid MEDLINE using the terms 'dementia' AND 'diagnosis OR detection'. In addition, articles from pertinent sources, such as Australian government reports and relevant websites (e.g. Dementia Australia) were included in the review. Results Literature was found for dementia diagnosis across general practice, hospitals, memory clinics, specialists, community, care institutions and new models. General practitioners are patients' preferred health professionals when dealing with dementia, but gaps in symptom recognition and initiation of cognitive testing lead to underdiagnosis. Hospitals are opportunistic places for dementia screening, but time constraints and acute medical issues hinder efficient dementia diagnosis. Memory clinics offer access to multidisciplinary skills, demonstrate earlier dementia diagnosis and potential cost-effectiveness, but are disadvantaged by organisational complexities. Specialists have increased confidence in diagnosing dementia than generalists, but drawbacks include long wait lists. Aged care assessment teams (ACAT) are a potential service for dementia diagnosis in the community. A multidisciplinary model for dementia diagnosis in care institutions is potentially beneficial, but is time and cost intensive. New models with technology allow dementia diagnosis in rural regions. Conclusion Memory clinics are most effective for formal dementia diagnosis, but healthcare professionals in other settings play vital roles in recognising patients with dementia and initiating investigations and referrals to appropriate services. What is known about this topic? Delays in dementia diagnosis are common, and it is unclear where majority of patients receive a diagnosis of dementia in Australia. While the Australian Clinical Practice Guidelines and Principles of Care for People with Dementia advocate referrals to services such as memory clinics for comprehensive assessment and diagnosis of dementia, such services may have limited capacity and may not be readily accessible to all. What does this paper add? This paper presents an overview of the various settings and services available for dementia diagnosis in Australia including evidence of the roles, accessibility, effectiveness and limitations of each setting. What are the implications for practitioners? This concerns a disease that is highly prevalent and escalating, and highlights the roles for practitioners in various settings including general practices, acute hospitals, specialist clinics, community and nursing homes. In particular, it discusses the potential roles, advantages and challenges of dementia diagnosis in each setting.
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Affiliation(s)
- Natalie Su Quin Ng
- Department of Rehabilitation and Aged Care Services, The Kingston Centre, Monash Health, 400 Warrigal Road, Cheltenham, Vic. 3192, Australia
| | - Stephanie Alison Ward
- Monash Ageing Research Centre (MONARC), Department of Epidemiology and Preventive Medicine, Monash University, The Kingston Centre, 400 Warrigal Rd, Cheltenham, Vic. 3192, Australia
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Lee L, Weston WW, Hillier L, Archibald D, Lee J. Improving family medicine resident training in dementia care: An experiential learning opportunity in Primary Care Collaborative Memory Clinics. GERONTOLOGY & GERIATRICS EDUCATION 2020; 41:447-462. [PMID: 29927720 DOI: 10.1080/02701960.2018.1484737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Family physicians often find themselves inadequately prepared to manage dementia. This article describes the curriculum for a resident training intervention in Primary Care Collaborative Memory Clinics (PCCMC), outlines its underlying educational principles, and examines its impact on residents' ability to provide dementia care. PCCMCs are family physician-led interprofessional clinic teams that provide evidence-informed comprehensive assessment and management of memory concerns. Within PCCMCs residents learn to apply a structured approach to assessment, diagnosis, and management; training consists of a tutorial covering various topics related to dementia followed by work-based learning within the clinic. Significantly more residents who trained in PCCMCs (sample = 98), as compared to those in usual training programs (sample = 35), reported positive changes in knowledge, ability, and confidence in ability to assess and manage memory problems. The PCCMC training intervention for family medicine residents provides a significant opportunity for residents to learn about best clinical practices and interprofessional care needed for optimal dementia care integrated within primary care practice.
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Affiliation(s)
- Linda Lee
- The Centre for Family Medicine Family Health Team, Kitchener, Canada
- Department of Family Medicine, McMaster University , Hamilton, Canada
| | - W Wayne Weston
- Schulich School of Medicine & Dentistry, Western University , London, Canada
| | - Loretta Hillier
- Geriatric Education and Research in Aging Sciences (GERAS) Centre, Hamilton Health Sciences Centre , Hamilton, Canada
| | - Douglas Archibald
- Department of Family Medicine, University of Ottawa, Bruyère Research Institute , Ottawa, Canada
| | - Joseph Lee
- Department of Family Medicine, McMaster University , Hamilton, Canada
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