Pathways to care among persons with dementia: Study from a tertiary care center

Hossien, Sk Altaf; Loganathan, Santosh; Murthy, Meena Kolar Sridara; Thangaraju, Sivakumar Palanimuthu; Bharath, Srikala; Varghese, Mathew

doi:10.1016/j.ajp.2017.07.002

Cited by 12 publications

(22 citation statements)

References 14 publications

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“…Our study provided a retrospective account of pathways taken by PwD and this implies that no data are available for patients who dropped out after the initial consultations. Indeed, the "fragmented" 19 or "non-cohesive" 27 pathway may be less accurately captured by this study approach. Finally, our survey did not include any measure of satisfaction of care throughout the entire pathway for dementia patients and their caregivers, while a more exhaustive evaluation of the dementia care process should include this aspect.…”

Section: Discussionmentioning

confidence: 96%

“…For example, in Pakistan, it was recently reported that in the entire country, with a population of more than 185 million, there was only one dementia specialist 18 . A recent study 19 attempted to characterize pathways to tertiary care for PwD in an Indian region and concluded that the major points of access for dementia patients were either general practitioners or specialists in neuropsychiatry, although other people were reported to follow a 'non-cohesive pattern'. While this study might have some interest from the perspective of dementia care in a low-middle income (LMIC) country, the small number of participants (N=35), the strictly regional focus, the qualitative approach and the use of a non-specific, semi-structured interviewing tool may limit the generalizability of those results, even for India which has wide regional variations in terms of health care and economy.…”

Section: Introductionmentioning

confidence: 99%

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Pathways to care for people with dementia: An international multicentre study

Volpe

Amin²,

Ayinde

et al. 2019

Int J Geriat Psychiatry

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Objective: the aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. Methods: we recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centers for dementia care in 15 countries. The WHO "Encounter Form", a standardized schedule that enables data concerning basic socio-demographic, clinical and pathways data to be gathered, was completed for each participant. Results: the median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy and practical advice) were delivered in less than 3% of situations. The analyses of the 'pathways diagram' revealed that the path of PwD to receiving care is complex, diverse across countries, and that there are important barriers to clinical care. Conclusions: the study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally and internationally.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Pathways to care for people with dementia: An international multicentre study

Volpe

Amin²,

Ayinde

et al. 2019

Int J Geriat Psychiatry

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“…On an average, two to four transitions from one source to another ensued before finally reaching a mental health professional [32,47,50]. On ultimately reaching the tertiary care setup, patients and their caregivers reported being satisfied with the illness-related information and with the management of symptoms [36]. Treatment was continued for a longer duration with more visits than other sources of help [46].…”

Section: Studies On Treatment-seeking Samplesmentioning

confidence: 99%

Help-seeking for mental health concerns: review of Indian research and emergent insights

Sanghvi

Mehrotra

2021

JHR

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PurposeThe purpose of this review was to examine Indian research on help-seeking for mental health problems in adults.Design/methodology/approachOriginal Indian research studies on help-seeking for mental health, published from the year 2001−2019 were searched on PubMed, EBSCO, ProQuest and OVID using a set of relevant keywords. After applying exclusion criteria, 52 relevant research studies were identified.FindingsThe reviewed studies spanned a variety of themes such as barriers and facilitators to help-seeking, sources of help-seeking, causal attributions as well as other correlates of help-seeking, process of help-seeking and interventions to increase help-seeking. The majority of these studies were carried out in general community samples or treatment-seeking samples. Very few studies incorporated non-treatment seeking distressed samples. There is a severe dearth of studies on interventions to improve help-seeking. Studies indicate multiple barriers to seeking professional help and highlight that mere knowledge about illness and availability of professional services may be insufficient to minimize delays in professional help-seeking.Originality/valueHelp-seeking in the Indian context is often a family-based decision-making process. Multi-pronged help-seeking interventions that include components aimed at reducing barriers experienced by non-treatment seeking distressed persons and empowering informal support providers with knowledge and skills for encouraging professional help-seeking in their significant others may be useful.

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“…The existing literature around help-seeking and pathways to care in LMICs often concludes that care pathways are inherently complex with many options, decision points, inflections, and routes. 17,30 Our findings, however, suggest that there is consistency in the pathway through care for women undergoing c-section in one rural district in Kirehe, Rwanda, a district with a relatively homogenous population in terms of income and education. A functionally shared pathway emerges for most women during their childbirth and postpartum care.…”

Section: Discussionmentioning

confidence: 64%

Synthesizing postpartum care pathways, facilitators, and barriers for women after cesarean section: a qualitative analysis from rural Rwanda

Powell

Nkurunziza

Kateera³

et al. 2021

Journal of Global Health Reports

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BackgroundIn low-and middle-income countries (LMICs), c-section is the most commonly performed operation, and surgical site infection (SSI) is the most common post-operative complication following all surgical procedures performed. Whilst multiple interventions have been rolled out to address high SSI rates, strategies for optimal care of patients at risk of developing SSIs need to include an understanding of the general care seeking behaviors, facilitators, and barriers among high-risk groups, including mothers delivering via c-section. This study explores the healthcare experiences of women who delivered by c-section section, from giving birth through recovery, and their associated decision-making, perceptions of care, and social and financial supports. MethodsWe conducted protocol-guided interviews in rural Kirehe District, Rwanda with twenty-five mothers who delivered by c-section at Kirehe District Hospital between February-April 2018, exploring their experience with delivery, hospitalization, recovery, and complications. Coded interviews were analyzed using the Grounded Theory approach to identify emergent themes. Thematic saturation was achieved. ResultsOverall, women largely followed the tiered referral system, as it was designed. A majority faced financial barriers to returning to care, and a majority were not able to describe the reason for their c-section, the complications experienced, or the treatment prescribed. We constructed a process map to summarize key steps where interventions should be designed to promote facilitators, to reduce barriers, and to identify and target the women being diverted from this designated path. ConclusionsUnderstanding the existing healthcare pathway and the associated facilitators and barriers among postpartum women is critical to designing appropriate interventions that properly serve their needs. Our findings strongly suggest that moving or complimenting post-operative wound assessments from the health center into home-based care, and ensuring unified messaging around c-section indications, care, and complications at the community-level are two of the areas that may improve utilization of existing healthcare infrastructure for women who deliver by c-section in rural districts in Rwanda.Cesarean section (c-section) is the most common major surgical procedure conducted in low-and middle-income countries (LMICs). 1,2 C-section poses inherent risks to patients, many of which occur at higher rates in LMICs. For all surgical procedures conducted, the most common postoperative complication is surgical site infection (SSI), with incidence estimated as high as 30.9% in some low-resource settings, [3][4][5][6][7][8][9][10][11][12] where high SSI rates have been associatedPowell BL, Nkurunziza T, Kateera F, et al. Synthesizing postpartum care pathways, facilitators, and barriers for women after cesarean section: a qualitative analysis from rural Rwanda.

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Pathways to care among persons with dementia: Study from a tertiary care center

Cited by 12 publications

References 14 publications

Pathways to care for people with dementia: An international multicentre study

Pathways to care for people with dementia: An international multicentre study

Help-seeking for mental health concerns: review of Indian research and emergent insights

Synthesizing postpartum care pathways, facilitators, and barriers for women after cesarean section: a qualitative analysis from rural Rwanda

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