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 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 Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review

2019 ◽  
Vol 69 (689) ◽  
pp. e809-e818 ◽  
Author(s):  
Sophie Chima ◽  
Jeanette C Reece ◽  
Kristi Milley ◽  
Shakira Milton ◽  
Jennifer G McIntosh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Making ◽  
Decision Support ◽  
Cost Effectiveness ◽  
Cancer Diagnosis ◽  
Decision Support Tools ◽  
Diagnostic Decision ◽  
Support Tools ◽  
Diagnostic Decision Making

BackgroundThe diagnosis of cancer in primary care is complex and challenging. Electronic clinical decision support tools (eCDSTs) have been proposed as an approach to improve GP decision making, but no systematic review has examined their role in cancer diagnosis.AimTo investigate whether eCDSTs improve diagnostic decision making for cancer in primary care and to determine which elements influence successful implementation.Design and settingA systematic review of relevant studies conducted worldwide and published in English between 1 January 1998 and 31 December 2018.MethodPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched, and a consultation of reference lists and citation tracking was carried out. Exclusion criteria included the absence of eCDSTs used in asymptomatic populations, and studies that did not involve support delivered to the GP. The most relevant Joanna Briggs Institute Critical Appraisal Checklists were applied according to study design of the included paper.ResultsOf the nine studies included, three showed improvements in decision making for cancer diagnosis, three demonstrated positive effects on secondary clinical or health service outcomes such as prescribing, quality of referrals, or cost-effectiveness, and one study found a reduction in time to cancer diagnosis. Barriers to implementation included trust, the compatibility of eCDST recommendations with the GP’s role as a gatekeeper, and impact on workflow.ConclusioneCDSTs have the capacity to improve decision making for a cancer diagnosis, but the optimal mode of delivery remains unclear. Although such tools could assist GPs in the future, further well-designed trials of all eCDSTs are needed to determine their cost-effectiveness and the most appropriate implementation methods.

scholarly journals The impact of asynchronous e-visits on clinical outcomes and healthcare delivery: A systematic review (Preprint)

2021 ◽  
Author(s):  
Oliver T. Nguyen ◽  
Amir Alishahi Tabriz ◽  
Jinhai Huo ◽  
Karim Hanna ◽  
Christopher M. Shea ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Of Care ◽  
Clinical Outcomes ◽  
Healthcare Costs ◽  
Healthcare Delivery ◽  
Healthcare Quality ◽  
Antibiotic Prescribing ◽  
Infection Management ◽  
The Impact

BACKGROUND E-visits involve asynchronous communication between providers and patients through a secure web-based platform, such as a patient portal, to elicit symptoms and determine a diagnosis and treatment plan. E-visits are now reimbursable through Medicare due to the COVID-19 pandemic. The state of the evidence regarding e-visits, such as the impact on clinical outcomes and healthcare delivery, is unclear. OBJECTIVE To address this gap, this systematic review examines how e-visits have impacted clinical outcomes and healthcare quality, access, utilization, and costs. METHODS MEDLINE, Embase, and Web of Science were searched from January 2000 through October 2020 for peer-reviewed studies that assessed e-visits’ impact on clinical and healthcare delivery outcomes. RESULTS Out of 1,858 papers, 19 studies met the inclusion criteria. E-visit usage was associated with improved or comparable clinical outcomes, especially for chronic disease management (e.g., diabetes care, blood pressure management). The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions but variable quality was observed in infection management (e.g., appropriate antibiotic prescribing). Similarly, the impact on healthcare utilization varied across conditions (e.g., lower utilization for dermatology) but mixed impact in primary care. Healthcare costs were lower for e-visits for a wide-range of conditions (e.g., dermatology and acute visits). No studies examined the impact of e-visits on healthcare access. Available studies are observational in nature and it is difficult to draw firm conclusions about effectiveness or impact on care delivery. CONCLUSIONS Overall, the evidence suggests e-visits may provide comparable clinical outcomes to in-person care and reduce healthcare costs for certain healthcare conditions. At the same time, there is mixed evidence on healthcare quality, especially regarding infection management (e.g., sinusitis, urinary tract infections, conjunctivitis). Further studies are needed to test implementation strategies that might improve delivery (e.g., clinical decision support for antibiotic prescribing) and to assess which conditions are amenable to e-visits and which conditions require in-person or face-to-face care (e.g., virtual visit). CLINICALTRIAL not applicable

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 Implementing dementia care models in primary care settings: The Aging Brain Care Medical Home

2010 ◽  
Vol 15 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Christopher M. Callahan ◽  
Malaz A. Boustani ◽  
Michael Weiner ◽  
Robin A. Beck ◽  
Lee R. Livin ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Home ◽  
Dementia Care ◽  
Aging Brain ◽  
Primary Care Settings ◽  
Care Models

scholarly journals Cost-effectiveness of collaborative care for the treatment of major depressive disorder in primary care. A systematic review

2010 ◽  
Vol 10 (1) ◽  
Author(s):  
Kirsten M van Steenbergen-Weijenburg ◽  
Christina M van der Feltz-Cornelis ◽  
Eva K Horn ◽  
Harm WJ van Marwijk ◽  
Aartjan TF Beekman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Major Depressive Disorder ◽  
Cost Effectiveness ◽  
Depressive Disorder ◽  
Collaborative Care ◽  
Major Depressive

scholarly journals Effect of computerised, knowledge-based, clinical decision support systems on patient-reported and clinical outcomes of patients with chronic disease managed in primary care settings: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e054659
Author(s):  
Marie line El Asmar ◽  
Kanika I Dharmayat ◽  
Antonio J Vallejo-Vaz ◽  
Ryan Irwin ◽  
Nikolaos Mastellos
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Support ◽  
Chronic Disease ◽  
Clinical Outcomes ◽  
Data Extraction ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Intervention Effect ◽  
Patient Reported

ObjectivesChronic diseases are the leading cause of disability globally. Most chronic disease management occurs in primary care with outcomes varying across primary care providers. Computerised clinical decision support systems (CDSS) have been shown to positively affect clinician behaviour by improving adherence to clinical guidelines. This study provides a summary of the available evidence on the effect of CDSS embedded in electronic health records on patient-reported and clinical outcomes of adult patients with chronic disease managed in primary care.Design and eligibility criteriaSystematic review, including randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, interrupted time series and controlled before-and-after studies, assessing the effect of CDSS (vs usual care) on patient-reported or clinical outcomes of adult patients with selected common chronic diseases (asthma, chronic obstructive pulmonary disease, heart failure, myocardial ischaemia, hypertension, diabetes mellitus, hyperlipidaemia, arthritis and osteoporosis) managed in primary care.Data sourcesMedline, Embase, CENTRAL, Scopus, Health Management Information Consortium and trial register clinicaltrials.gov were searched from inception to 24 June 2020.Data extraction and synthesisScreening, data extraction and quality assessment were performed by two reviewers independently. The Cochrane risk of bias tool was used for quality appraisal.ResultsFrom 5430 articles, 8 studies met the inclusion criteria. Studies were heterogeneous in population characteristics, intervention components and outcome measurements and focused on diabetes, asthma, hyperlipidaemia and hypertension. Most outcomes were clinical with one study reporting on patient-reported outcomes. Quality of the evidence was impacted by methodological biases of studies.ConclusionsThere is inconclusive evidence in support of CDSS. A firm inference on the intervention effect was not possible due to methodological biases and study heterogeneity. Further research is needed to provide evidence on the intervention effect and the interplay between healthcare setting features, CDSS characteristics and implementation processes.PROSPERO registration numberCRD42020218184.

scholarly journals Towards Consensus on Essential Components of Physical Examination in Primary Care-based Memory Clinics*

2018 ◽  
Vol 21 (2) ◽  
pp. 143-151 ◽  
Author(s):  
George A. Heckman ◽  
Bryan B. Franco ◽  
Linda Lee ◽  
Loretta Hillier ◽  
Veronique Boscart ◽  
...  
Keyword(s):  
Primary Care ◽  
Physical Examination ◽  
Overall Response Rate ◽  
Response Rate ◽  
Vital Signs ◽  
Online Surveys ◽  
Essential Components ◽  
Memory Clinics ◽  
Memory Concerns ◽  
With Memory

BackgroundPrimary care-based memory clinics were established to meet the needs of persons with memory concerns. We aimed to identify: 1) physical examination maneuvers required to assess persons with possible dementia in specialist-supported primary care-based memory clinics, and 2) the best-suited clinicians to perform these maneuvers in this setting.MethodsWe distributed in-person and online surveys of clinicians in a network of 67 primary care-based memory clinics in Ontario, Canada.Results90 surveys were completed for an overall response rate of 66.7%. Assessments of vital signs, gait, and for features of Parkinsonism were identified as essential by most respondents. There was little consensus on which clinician should be responsible for specific physical examination maneuvers.ConclusionsWhile we identified specific physical examination maneuvers deemed by providers to be both necessary and feasible to perform in the context of primary care-based memory clinics, further research is needed to clarify interprofessional roles related to the examination.

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