The Impact of Ambulatory Dementia Care Models on Hospitalization of Persons Living With Dementia: A Systematic Review

2021 ◽  
pp. 016402752110532
Author(s):  
Vaneh Hovsepian ◽  
Ani Bilazarian ◽  
Amelia E. Schlak ◽  
Tatiana Sadak ◽  
Lusine Poghosyan
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Ambulatory Care ◽  
Dementia Care ◽  
Community Based ◽  
Future Studies ◽  
Memory Care ◽  
Care Models ◽  
The Impact ◽  
Modest Reduction

This systematic review presents an overview of the existing dementia care models in various ambulatory care settings under three categories (i.e., home- and community-based care models, partnership between health systems and community-based resources, and consultation models) and their impact on hospitalization among Persons Living with Dementia (PLWD). PRISMA guidelines were applied, and our search resulted in a total of 13 studies focusing on 11 care models. Seven studies reported that utilization of dementia care models was associated with a modest reduction in hospitalization among community-residing PLWD. Only two studies reported statistically significant results. Dementia care models that were utilized in specialty ambulatory care settings such as memory care showed more promising results than traditional primary care. To develop a better understanding of how dementia care models can be improved, future studies should explore how confounders (e.g., stage of dementia) influence hospitalization.

scholarly journals Effectiveness of different post-diagnostic dementia care models delivered by primary care: a systematic review

2020 ◽  
Vol 70 (695) ◽  
pp. e434-e441
Author(s):  
Rachael Frost ◽  
Kate Walters ◽  
Su Aw ◽  
Greta Brunskill ◽  
Jane Wilcock ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Cost Effectiveness ◽  
Clinical Outcomes ◽  
Healthcare Costs ◽  
Dementia Care ◽  
Care Models ◽  
Memory Clinics ◽  
Partnership Models ◽  
With Memory

BackgroundGlobal policy recommendations suggest a task-shifted model of post-diagnostic dementia care, moving towards primary and community-based care. It is unclear how this may best be delivered.AimTo assess the effectiveness and cost-effectiveness of primary care-based models of post-diagnostic dementia care.Design and settingA systematic review of trials and economic evaluations of post-diagnostic dementia care interventions where primary care was substantially involved in care plan decision making.MethodSearches were undertaken of MEDLINE, PsychINFO, EMBASE, Web of Science, and CINAHL (from inception to March 2019). Two authors independently critically appraised studies and inductively classified interventions into types of care models. Random effects meta-analysis or narrative synthesis was conducted for each model where appropriate.ResultsFrom 4506 unique references and 357 full texts, 23 papers were included from 10 trials of nine interventions, delivered in four countries. Four types of care models were identified. Primary care provider (PCP)-led care (n = 1) led to better caregiver mental health and reduced hospital and memory clinic costs compared with memory clinics. PCP-led care with specialist consulting support (n = 2) did not have additional effects on clinical outcomes or costs over usual primary care. PCP–case management partnership models (n = 6) offered the most promise, with impact on neuropsychiatric symptoms, caregiver burden, distress and mastery, and healthcare costs. Integrated primary care memory clinics (n = 1) had limited evidence for improved quality of life and cost-effectiveness compared with memory clinics.ConclusionPartnership models may impact on some clinical outcomes and healthcare costs. More rigorous evaluation of promising primary care-led care models is needed.

The impact of participant pathways on the effectiveness of a community-based physical activity intervention grounded in motivational interviewing

2020 ◽  
Author(s):  
Matthew Wade ◽  
Nicola Brown ◽  
James Steele ◽  
Steven Mann ◽  
Bernadette Dancy ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Motivational Interviewing ◽  
Social Action ◽  
Multilevel Models ◽  
Physical Activity Intervention ◽  
Mental Wellbeing ◽  
Community Based ◽  
The Impact ◽  
Time Point

Background: Brief advice is recommended to increase physical activity (PA) within primary care. This study assessed change in PA levels and mental wellbeing after a motivational interviewing (MI) community-based PA intervention and the impact of signposting [SP] and Social Action [SA] (i.e. weekly group support) pathways. Methods: Participants (n=2084) took part in a community-based, primary care PA programme using MI techniques. Self-reported PA and mental wellbeing data were collected at baseline (following an initial 30-minute MI appointment), 12-weeks, six-months, and 12-months. Participants were assigned based upon the surgery they attended to the SP or SA pathway. Multilevel models were used to derive point estimates and 95%CIs for outcomes at each time point and change scores. Results: Participants increased PA and mental wellbeing at each follow-up time point through both participant pathways and with little difference between pathways. Retention was similar between pathways at 12-weeks, but the SP pathway retained more participants at six-months and 12-months. Conclusions: Both pathways produced similar improvements in PA and mental wellbeing, suggesting the effectiveness of MI based PA interventions. However, due to lower resources required yet similar effects, SP pathways are recommended over SA to support PA in primary care settings.

scholarly journals A Multiple Stakeholder Perspective for Evaluating Community-Based Dementia Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 60-61
Author(s):  
Johan Suen
Keyword(s):  
Dementia Care ◽  
Structural Constraints ◽  
Care Provision ◽  
Care Providers ◽  
Structured Interviews ◽  
Community Based ◽  
Relational Factors ◽  
Care Relationships ◽  
The Individual ◽  
The Impact

Abstract For holistic interventions and research on dementia, it is fundamental to understand care experiences from the perspectives of carers, care recipients, and care professionals. While research on care dyads and triads have highlighted the effects of communication and interactional aspects on care relationships, there is a lack of knowledge on how individual-contextual and relational factors shape the provision and receipt of care in terms of decision-making processes, resource allocation, and expectations of care outcomes. Thus, this paper sheds light on (i) how carers negotiate care provision with other important life domains such as employment, household/family roles and conflicts, as well as their own health problems, life goals, values, and aspirations for ageing; (ii) how older adults with dementia perceive support and those who provide it; (iii) the structural constraints faced by care professionals in delivering a team-based mode of dementia care; and, taken together, (iv) how community-based dementia care is impeded by barriers at the individual, relational, and institutional levels. Findings were derived from semi-structured interviews and observational data from fieldwork conducted with 20 persons with dementia (median age = 82), 20 of their carers (median age = 60), and 4 professional care providers. All respondents were clients and staff of a multidisciplinary and community-based dementia care system in Singapore. Our analysis indicates the impact of dementia care is strongly mediated by the interplay between institutional/familial contexts of care provision and the various ‘orientations’ to cognitive impairment and seeking support, which we characterised as ‘denial/acceptance’, ‘obligated’, ‘overprotective’, and ‘precariously vulnerable’.

scholarly journals Reducing unscheduled hospital care for adults with diabetes following a hypoglycaemic event: which community-based interventions are most effective? A systematic review

2021 ◽  
Author(s):  
Aoife Watson ◽  
Donna McConnell ◽  
Vivien Coates
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Integrated Care ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Community Based Interventions ◽  
Community Based ◽  
Integrated Care Pathways ◽  
Effective Community ◽  
Balance Of Care

Abstract Aim To determine which community-based interventions are most effective at reducing unscheduled hospital care for hypoglycaemic events in adults with diabetes. Methods Medline Ovid, CINAHL Plus and ProQuest Health and Medical Collection were searched using both key search terms and medical subject heading terms (MeSH) to identify potentially relevant studies. Eligible studies were those that involved a community-based intervention to reduce unscheduled admissions in adults with diabetes. Papers were initially screened by the primary researcher and then a secondary reviewer. Relevant data were then extracted from papers that met the inclusion criteria. Results The search produced 2226 results, with 1360 duplicates. Of the remaining 866 papers, 198 were deemed appropriate based on titles, 90 were excluded following abstract review. A total of 108 full papers were screened with 19 full papers included in the review. The sample size of the 19 papers ranged from n = 25 to n = 104,000. The average ages within the studies ranged from 41 to 74 years with females comprising 57% of the participants. The following community-based interventions were identified that explored reducing unscheduled hospital care in people with diabetes; telemedicine, education, integrated care pathways, enhanced primary care and care management teams. Conclusions This systematic review shows that a range of community-based interventions, requiring different levels of infrastructure, are effective in reducing unscheduled hospital care for hypoglycaemia in people with diabetes. Investment in effective community-based interventions such as integrated care and patient education must be a priority to shift the balance of care from secondary to primary care, thereby reducing hospital admissions.

Breast Density Notification: A Systematic Review of the Impact on Primary Care Practitioners

2021 ◽  
Author(s):  
Brooke Nickel ◽  
Tessa Copp ◽  
Meagan Brennan ◽  
Rachel Farber ◽  
Kirsten McCaffery ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Breast Density ◽  
Primary Care Practitioners ◽  
The Impact

scholarly journals Promoting cross-jurisdictional primary health care research: developing a set of common indicators across 12 community-based primary health care teams in Canada

2018 ◽  
Vol 20 ◽  
Author(s):  
Sabrina T. Wong ◽  
Julia M. Langton ◽  
Alan Katz ◽  
Martin Fortin ◽  
Marshall Godwin ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Working Group ◽  
Scale Up ◽  
Data Sources ◽  
Knowledge Generation ◽  
Community Based ◽  
Primary Health ◽  
The Impact

AbstractAimTo describe the process by which the 12 community-based primary health care (CBPHC) research teams worked together and fostered cross-jurisdictional collaboration, including collection of common indicators with the goal of using the same measures and data sources.BackgroundA pan-Canadian mechanism for common measurement of the impact of primary care innovations across Canada is lacking. The Canadian Institutes for Health Research and its partners funded 12 teams to conduct research and collaborate on development of a set of commonly collected indicators.MethodsA working group representing the 12 teams was established. They undertook an iterative process to consider existing primary care indicators identified from the literature and by stakeholders. Indicators were agreed upon with the intention of addressing three objectives across the 12 teams: (1) describing the impact of improving access to CBPHC; (2) examining the impact of alternative models of chronic disease prevention and management in CBPHC; and (3) describing the structures and context that influence the implementation, delivery, cost, and potential for scale-up of CBPHC innovations.FindingsNineteen common indicators within the core dimensions of primary care were identified: access, comprehensiveness, coordination, effectiveness, and equity. We also agreed to collect data on health care costs and utilization within each team. Data sources include surveys, health administrative data, interviews, focus groups, and case studies. Collaboration across these teams sets the foundation for a unique opportunity for new knowledge generation, over and above any knowledge developed by any one team. Keys to success are each team’s willingness to engage and commitment to working across teams, funding to support this collaboration, and distributed leadership across the working group. Reaching consensus on collection of common indicators is challenging but achievable.

scholarly journals Implementing post diagnostic dementia care in primary care: a mixed-methods systematic review

2020 ◽  
pp. 1-14
Author(s):  
Rachael Frost ◽  
Greta Rait ◽  
Su Aw ◽  
Greta Brunskill ◽  
Jane Wilcock ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Mixed Methods ◽  
Dementia Care

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

2020 ◽  
Vol 28 (3) ◽  
pp. 320-330 ◽  
Author(s):  
Hannah Heintz ◽  
Patrick Monette ◽  
Gary Epstein-Lubow ◽  
Lorie Smith ◽  
Susan Rowlett ◽  
...  
Keyword(s):  
Primary Care ◽  
Collaborative Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Dementia Care ◽  
Narrative Review ◽  
Care Models

scholarly journals Redefining the Care Continuum to Create a Pipeline to Dementia Care for Minority Populations

2020 ◽  
Vol 11 ◽  
pp. 215013272092168
Author(s):  
Tina R. Sadarangani ◽  
Vanessa Salcedo ◽  
Joshua Chodosh ◽  
Simona Kwon ◽  
Chau Trinh-Shevrin ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Asian American ◽  
Minority Groups ◽  
Primary Care Providers ◽  
Dementia Care ◽  
Care Providers ◽  
Community Based ◽  
Community Based Organizations

Multiple studies show that racial and ethnic minorities with low socioeconomic status are diagnosed with Alzheimer’s disease and Alzheimer’s disease–related dementias (AD/ADRD) in more advanced disease stages, receive fewer formal services, and have worse health outcomes. For primary care providers confronting this challenge, community-based organizations can be key partners in supporting earlier identification of AD/ADRD and earlier entry into treatment, especially for minority groups. The New York University Center for the Study of Asian American Health, set out to culturally adapt and translate The Kickstart-Assess-Evaluate-Refer (KAER) framework created by the Gerontological Society of America to support earlier detection of dementia in Asian American communities and assist in this community-clinical coordinated care. We found that CBOs play a vital role in dementia care, and are often the first point of contact for concerns around cognitive impairment in ethnically diverse communities. A major strength of these centers is that they provide culturally appropriate group education that focuses on whole group quality of life, rather than singling out any individual. They also offer holistic family-centered care and staff have a deep understanding of cultural and social issues that affect care, including family dynamics. For primary care providers confronting the challenge of delivering evidence-based dementia care in the context of the busy primary care settings, community-based organizations can be key partners in supporting earlier identification of AD/ADRD and earlier entry into treatment, especially for minority groups.

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