Case management for dementia in primary health care: a systematic mixed studies review based on the diffusion of innovation model

Khanassov, Vladimir; Vedel, Isabelle; Pluye, Pierre

doi:10.2147/cia.s64723

Cited by 54 publications

(77 citation statements)

References 45 publications

(169 reference statements)

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“…A number of systematic reviews have been reported of studies assessing the impact of case management on older people with dementia. [183][184][185][186][187][188][189] In general, studies have provided conflicting information about the potential benefits and duration of effect of case management for people with dementia. A recent Cochrane review of case management for PLWD found that the case management group was significantly less likely to be institutionalised at 6 and 12 months than those not receiving case management, although the longer-term effects were uncertain.…”

Section: Co-ordination and Navigationmentioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Co-ordination and Navigationmentioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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“…The reviewers described high-intensity case management as (1) a caseload of fewer than 50 patients per fulltime equivalence, (2) regular meetings with the informal caregiver and the patient with at least 50% of these meetings being face to face, (3) education on health conditions, (4) close contact with family physicians, 9,32 and (5) proactive and timely follow-up 9,33 and following up with patients during hospitalizations and short-term institutionalizations. 9,34 In our study, both case management groups exceed this case load recommendation and it is unclear how they rate on the other factors. The average caseloads being over the recommendation of the review could be a possible reason for there being little difference among all groups.…”

Section: Comparison With Literaturementioning

confidence: 53%

“…It is possible that participants in our study had more behavior problems, as total NPI mean baseline scores were higher in our population compared with the patient population in Callahan et al 31 A review that included both qualitative and quantitative studies looked at facilitators and barriers to successful case management implementation in the primary health care setting. 9 Results indicated that high-intensity case management was necessary and sufficient to produce positive clinical outcomes for patients and to optimize service use. The reviewers described high-intensity case management as (1) a caseload of fewer than 50 patients per fulltime equivalence, (2) regular meetings with the informal caregiver and the patient with at least 50% of these meetings being face to face, (3) education on health conditions, (4) close contact with family physicians, 9,32 and (5) proactive and timely follow-up 9,33 and following up with patients during hospitalizations and short-term institutionalizations.…”

Section: Comparison With Literaturementioning

confidence: 99%

“…5e8 However, reviews and meta-analyses have yielded inconsistent results regarding case management on patient and caregiver outcomes in care satisfaction, institutionalization, hospitalization, caregiver burden, depression, and economic outcomes. 5e7, 9 In the Netherlands, various models of case management are implemented. These differ with respect to how services are delivered and by whom, the training provided to its staff, and the means of financing.…”

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confidence: 99%

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Community-Dwelling Patients With Dementia and Their Informal Caregivers With and Without Case Management: 2-Year Outcomes of a Pragmatic Trial

Vroomen

Bosmans

Ven

et al. 2015

Journal of the American Medical Directors Association

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“…[14][15][16][17][18][20][21][22] Our previous studies demonstrated that the effectiveness of CM depends on a small caseload, regular and proactive follow-up, and transparent communication among health care professionals. 110,111 Limitations As in any systematic review, we may have missed studies that we should have included. It is unlikely, however, that we missed large studies, as the literature search was comprehensive and included publications in 3 languages (English, French, and Russian).…”

Section: Discussionmentioning

confidence: 99%

Family Physician–Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review

Khanassov

Vedel

2016

Ann Fam Med

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PURPOSE Dementia case management (CM) in primary care is a complex intervention aimed at identifying the various needs of patients with dementia and their caregivers, as well as the organization and coordination of care. A key element of CM is the collaboration of family physicians with case managers. We conducted a systematic mixed-studies review to identify the needs of the patientcaregiver dyad and the effects of CM. METHODSWe searched MEDLINE, PsycINFO, and EMBASE up to October 2014, regardless of the study design. Our main outcomes were needs of patients and their caregivers and the effects of CM on these needs. We used narrative syntheses to develop a taxonomy of needs and to describe the effects of CM on those needs. We used meta-analysis to calculate the prevalence of needs and the standardized mean differences to evaluate the effects of CM on the needs identified.RESULTS Fifty-four studies were included. We identified needs of the patientcaregiver dyad and needs of the patient and caregiver individually. CM addressed the majority of the identified needs. Still, some very common needs (eg, early diagnosis) are overlooked while other needs (eg, education on the disease) are well addressed. Fully establishing the value of CM is difficult given the small number of studies of CM in primary care.CONCLUSIONS There is good evidence that case managers, in collaboration with family physicians, have a pivotal role in addressing the needs of the patientcaregiver dyad. 2016;14:166-177. doi: 10.1370/afm.1898. Ann Fam Med INTRODUCTIONT he proportion of people with dementia is growing dramatically. According to the US Alzheimer's Association, by 2030, 50% of Americans aged 65 years and older will be diagnosed with dementia. 1 In Canada in 2011, 747,000 Canadians lived with cognitive impairment.2 Today, the combined costs are $33 billion per year, 1 and they are projected to increase to $872 billion by 2038. 3,4 Worldwide, dementia is the main contributor to disability-adjusted life years (11.2%), representing a greater burden than cerebral vascular accident (9.5%), heart disease (5.0%), or cancer (2.4%). 5People with dementia need help with challenging changes in behavior, memory, physical disability, and mood. 6 The main source of help is family caregivers, who often suffer from the burdens of caregiving and from depression and health problems. 7 It has been shown that early intervention makes the greatest difference in management of symptoms. 1 The World Health Organization states that it would be challenging to intervene without effective involvement of primary care. 8 Dementia case management (CM) interventions are becoming a central component of primary health care organizations in North America and Europe. [9][10][11][12] According to the 167Case Management Society of America, case management is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communi...

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Case management for dementia in primary health care: a systematic mixed studies review based on the diffusion of innovation model

Cited by 54 publications

References 45 publications

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Community-Dwelling Patients With Dementia and Their Informal Caregivers With and Without Case Management: 2-Year Outcomes of a Pragmatic Trial

Family Physician–Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review

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