Evaluation of an integrated service delivering post diagnostic care and support for people living with dementia and their families

Abstract

Greater integration of health and social care services is considered vital to ensure sustainable long-term quality provision for the growing numbers of people living with dementia and their families. Integration of services is at the heart of government policy in England. We evaluated a new integrated service for post diagnostic dementia care, funded as a pilot and delivered through a partnership of statutory and voluntary sector health and social care organisations. The service used an adapted Admiral Nursing service model with a workforce of Admiral Nurses (ANs) and Dementia Advisers (DAs). A mixed method approach was used to assess implementation and outcomes. It involved collection of service activity data, carer reported experience survey data, focus group discussions and interviews with the service delivery team, and the management group. Qualitative data was analysed using a framework approach. About 37.8% of the eligible population registered with the service over the 14-month pilot period. The self-referral route accounted for the majority of referrals, and had enabled those not currently receiving specialist dementia care to engage with the service. Carer satisfaction surveys indicated high levels of satisfaction with the service. The caseload management system offered specific benefits. Individual caseloads ensured continuity of care while the integrated structure facilitated seamless transfer between or shared working across AN and DA caseloads. The skill mix facilitated development of the DA role increasing their potential contribution to dementia care. Challenges included managing large workloads and agreeing responsibilities across the skill mix of staff. This model of fully integrated service offers a novel approach to address the problems of fragmented provision by enabling joined-up working across health and social care.

Integrated dementia care: A qualitative evidence synthesis of the experiences of people living with dementia, informal carers and healthcare professionals

“…The 23 included studies were published between 2006 and 2019, with the majority (17) published after 2014. Twelve were conducted in the United Kingdom (Bamford et al, 2014;Bunn et al, 2017;Carter et al, 2017;Davies et al 2014;Gage et al, 2012;Kümpers et al 2006;Kupeli et al, 2016;Piercy et al, 2018;Robertshaw & Cross, 2017;Robertshaw & Cross, 2018;Smith, 2016;Woolrych & Sixsmith, 2013); three in Australia (Bauer et al, 2011;Luckett et al, 2017;Robinson et al, 2009); three in the Netherlands (de Lange et al, 2016;Minkman et al, 2009;van Mierlo et al, 2014); two in Canada (Heckman et al 2019;Kosteniuk et al 2014); two in Japan (Hirakawa et al, 2017;Hirakawa et al, 2019); and one in Spain (Risco et al 2016). Apart from two mixed methods studies (Gage et al, 2012;Piercy et al, 2018), all were qualitative.…”

“…Twelve investigated the experiences and perceptions of health care professionals (e.g. GPs; nurses; social workers), care workers or programme managers (Bamford et al, Carter et al, 2017;Davies et al 2014;de Lange et al, 2016;Gage et al, 2012;Heckman et al 2019;Hirakawa et al, 2017;Hirakawa et al, 2019;Kosteniuk et al, 2014;Kupeli et al, 2016;Luckett et al, 2017;Minkman et al, 2009;Piercy et al, 2018;Smith, 2016;van Mierlo et al, 2014;Woolrych & Sixsmith, 2013); five included a combination of health care professionals and informal carers (Bunn et al, 2017;Kümpers et al 2006;Risco et al 2016;Robertshaw & Cross, 2017;Robertshaw & Cross, 2018) and two exclusively on informal carers (Bauer et al, 2011;Robinson et al, 2009). Three studies also included the perceptions of people living with dementia (Bamford et al, 2014;Bunn et al, 2017;Risco et al 2016).…”

“…To overcome challenges associated with interprofessional communication and collaboration, health and social care services need to be seamlessly joined up, allowing close working relationships between healthcare professionals for integrated care to develop (Bunn et al, 2017;Davies et al 2014;Kosteniuk et al, 2014;Piercy et al, 2018). Some healthcare professionals and specialists were proactively developing working arrangements which promoted collaboration and approaches to integrate care (Heckman et al 2019).…”

“…Some healthcare professionals and specialists were proactively developing working arrangements which promoted collaboration and approaches to integrate care (Heckman et al 2019). Healthcare professionals meeting either face-to-face or via case conferencing to discuss clients' needs has been shown to increase knowledge transfer, improve integrated care and highlighted changing care needs for people living with dementia (Kümpers et al 2006;Luckett et al, 2017;Piercy et al, 2018). A way of improving communication and collaboration among healthcare professionals was through the development of multidisciplinary teams.…”

ABC model: A tiered, integrated pathway approach to peri- and post-diagnostic support for families living with dementia (Innovative Practice)

“…sites to replicate the model of care was in the North of England and was established by joint health and social care commissioning arrangements encouraging collaborative working with six partner organisations. A recent evaluation of this service highlighted clear benefits of bringing together Admiral Nurses and Dementia Advisers within a single workforce (Piercy, Fowler-Davis, Dunham, & Cooper, 2018). Shared clinical processes including a single assessment and the triage process together with seamless transfer between Admiral Nurses and Dementia Advisors caseloads enabled resources to be targeted in a timely and appropriate manner (Piercy et al, 2018).…”