Emerging Collaborative Care Models for Dementia Care in the Primary Care Setting: A Narrative Review

Heintz, Hannah; Monette, Patrick; Epstein‐Lubow, Gary; Smith, Leslie M.; Rowlett, Susan; Forester, Brent P.

doi:10.1016/j.jagp.2019.07.015

Cited by 54 publications

(61 citation statements)

References 50 publications

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“…It worked with professional organizations, healthcare systems, and health plans on such training programs and developed a partnership with the American Psychiatric Association to train over 3000 psychiatrists around the country in collaborative care with funding from the Center for Medicare and Medicaid Innovation. Over the past decade, more than 10,000 individuals from thousands of primary care clinics have participated in training programs supported by the AIMS Center with the help of print and on‐line materials, videos, and other materials, many of which are available on the AIMS website 31 …”

Section: Lessons From the Experience Of Developing Implementing And Diffusing The Collaborative Care Model For People Living With Depressmentioning

confidence: 99%

“…However, the collaborative ADRD care model is difficult to scale and sustain without sufficient market demand for the delivery of this model within primary care giving the need of delivering ADRD care within the context of managing multiple chronic conditions. It is estimated that more than half of patients living with ADRD suffer from at least five other conditions 1,2,5,31 . Primary care clinicians are the most qualified clinicians to manage such a complexity.…”

Section: Primary Care Practices Are the Main Healthcare Delivery Organizations For Adrd Carementioning

confidence: 99%

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Design, implement, and diffuse scalable and sustainable solutions for dementia care

Boustani

Unützer

Leykum

2021

J American Geriatrics Society

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Most innovations developed to reduce the burden of Alzheimer disease and other related dementias (ADRD) are difficult to implement, diffuse, and scale.The consequences of such challenges in design, implementation, and diffusion are suboptimal care and resulting harm for people living with ADRD and their caregivers. National experts identified four factors that contribute to our limited ability to implement and diffuse of evidence-based services and interventions for people living with ADRD: (1) limited market demand for the implementation and diffusion of effective ADRD interventions; (2) insufficient engagement of persons living with ADRD and those caring for them in the development of potential ADRD services and interventions; (3) limited evidence and experience regarding scalability and sustainability of evidence-based ADRD care services; and (4) difficulties in taking innovations that work in one context and successfully implementing them in other contexts. New investments in the science of human-centered design, implementation, and diffusion are crucial for meeting the goals of the National Plan to Address Alzheimer's Disease under the auspices of the National Alzheimer's Project Act.

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Section: Lessons From the Experience Of Developing Implementing And Diffusing The Collaborative Care Model For People Living With Depressmentioning

confidence: 99%

Section: Primary Care Practices Are the Main Healthcare Delivery Organizations For Adrd Carementioning

confidence: 99%

Design, implement, and diffuse scalable and sustainable solutions for dementia care

Boustani

Unützer

Leykum

2021

J American Geriatrics Society

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“…While it is acknowledged that the management of dementia with its progressive cognitive, functional, physical and psychiatric changes is complex [ 10 ], people living with dementia (PLWD) have a fundamental human right to accessible, equitable primary care [ 11 ]. Barriers to the provision of optimal care include high care demands, requiring increased time, and continuing care which may result in the needs of people living with dementia not able to be met by the General Practitioner (GP) alone [ 1 , 8 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

The provision of dementia care in general practice: practice nurse perceptions of their role

et al. 2021

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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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“…For the person with dementia, a collaborative care model results in fewer ER visits and acute hospitalizations ( 13 ), an improvement in neuropsychological symptoms ( 14 ), and cognitive symptoms ( 15 ), earlier diagnosis ( 16 ), and better satisfaction with care ( 17 ). For caregivers, such a model can improve depressive symptoms ( 14 ), decreased burden ( 18 ), and result in higher satisfaction with care ( 17 ), shorter waiting times and a reduction in time to diagnosis ( 19 , 20 ).…”

Section: Introductionmentioning

confidence: 99%

Evaluating a Memory Clinic Using the RE-AIM Model. The Experience of the “Memory and Neuropsychiatry Clinic” in Hospital Del Salvador, Chile

et al. 2021

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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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Emerging Collaborative Care Models for Dementia Care in the Primary Care Setting: A Narrative Review

Cited by 54 publications

References 50 publications

Design, implement, and diffuse scalable and sustainable solutions for dementia care

Design, implement, and diffuse scalable and sustainable solutions for dementia care

The provision of dementia care in general practice: practice nurse perceptions of their role

Evaluating a Memory Clinic Using the RE-AIM Model. The Experience of the “Memory and Neuropsychiatry Clinic” in Hospital Del Salvador, Chile

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