centre for research in geriatric medicine t he k nowledge t ranslation p athway for timely d...
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Centre for Research in Geriatric Medicine
Centre for Research in Geriatric Medicine
THE KNOWLEDGE TRANSLATION PATHWAY
FOR TIMELY DIAGNOSIS OF DEMENTIA
Catherine Travers
Centre for Research in Geriatric Medicine
PROJECT FOCUS
Service Models
Improving access
Diagnosis of Dementia
Centre for Research in Geriatric Medicine
Research Support
Co-InvestigatorsDr. Melinda Martin-Khan PhD
Centre for Research in Geriatric Medicine, The University of Queensland, AUS
Dr. David Lie Older Persons Mental Health, Queensland Health, AUS
Dr. Catherine Travers PhD
Queensland Dementia Training Study Centre (DTSC), Queensland University of Technology, AUS
Financial Support– Dementia Collaborative Research
Centre – Early Detection and Prevention
Centre for Research in Geriatric Medicine
Background: When …..
Diagnosis of dementia:
OPTIONS FOR IDENITFICATION…..
– Gene testing– Risk assessment– Early Screening– Case finding
– Review of existing symptoms
Centre for Research in Geriatric Medicine
Background: Why …..
Diagnosis of Dementia– Protracted process– Challenging to diagnosis in the early stages
Delays can occur because– Lack of recognition of early cognitive decline– Limited understanding of any potential benefits of early
recognition of dementia– Delayed access in the diagnostic process
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Background: Why…..
Cahill, S., M. Clark, H. O'Connell, B. Lawlor, R. F. Coen and C. Walsh (2008). "The attitudes and practices of general practitioners regarding dementia diagnosis in Ireland." International Journal Of Geriatric Psychiatry 23(7): 663-669.
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Background: Why…..
Armari, E., A. Jarmolowicz and P. K. Panegyres (2013). "The needs of patients with early onset dementia." American Journal Of Alzheimer's Disease And Other Dementias 28(1): 42-46.
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Background: Policy Recognition…..
International Frameworks for Dementia include:
Public education campaigns to improve public and professional awareness and understanding of dementia
Promotion of early/ timely diagnosis
Increase the workforce to meet the likely increase in demand for services as a result of education
Provide sufficient guidance and support for people with dementia and their carers
Travers, C., D. Lie, L. Halliday and M. Martin-Khan (2012). Towards a National Framework for Dementia Prevention, Promotion and Early Intervention: What are the Options? Report for the Dementia Collaborative Research Centre - Prevention, Early Intervention and Risk Reduction (DCRC-EDP). Brisbane, The University of Queensland.
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Background: The need…..
Recognised long gap between when people first seek help and when they finally receive a definitive diagnosis
Focus on improving the support for people who are at the point where they are seeking help
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Aim
Identify models of service described in the
published literature which focus on improving access
to a dementia diagnostic process (usually
formal assessment by a specialist or general practitioner)
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Method
LITERATURE SEARCH– Medline, PubMed, Cinahl, Health Source: Nursing Academic Edition– Completed November 2013– Excluded: Non-English papers, Publications prior to 1990
INCLUSION/EXCLUSION CRITERIA
INCLUSION EXCLUSION
Reference to Dementia Treatment of Dementia
Diagnostic Diagnostic tool development
Focus on implementation related to timing (interventions improving access)
Epidemiological studies (describing risk profiles or prevalence)
Models of service Barriers or Enablers (Patient specific)
Older adults General mental health services
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Method
KEY WORDS– Dementia, and Alzheimer’s Disease (and the dementia sub-types)– Diagnosis (including ‘delayed diagnosis’; ‘early diagnosis’)– Access (‘Health services accessibility’ and ‘Health care access’)– Health Services Research
SEARCH STRATEGY– TWO COMBINATIONS
• (1) Dementia AND Diagnosis AND Access;• (2) Dementia AND Diagnosis AND Health Services Research
• Either 1 OR 2
Centre for Research in Geriatric MedicineCentre for Research in Geriatric Medicine
RESULTS: EXAMPLES OF MODELS OF SERVICE
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Referral to Memory Clinics
LOCATION: NETHERLANDS– Memory clinics moving
away from Tertiary teaching hospitals (increased collaboration with regional care organisations)
Ramakers, I. H. G. B. and F. R. J. Verhey (2011). "Development of memory clinics in the Netherlands: 1998 to 2009." Aging & Mental Health 15(1): 34-39.
– Usually two or more specialists– Referral required to the memory clinic– Traditional assessment process– Improving Access: Increasing number of clinics
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Referral to Memory Clinics
Banerjee, S., R. Willis, D. Matthews, F. Contell, J. Chan and J. Murray (2007). "Improving the quality of care for mild to moderate dementia: an evaluation of the Croydon Memory Service Model." International Journal Of Geriatric Psychiatry 22(8): 782-788.
LOCATION: ENGLAND– Fast assessment process– Service Model Developed:
Croydon Memory Service Model (CMSM)
• Generic clinical team• All individuals, regardless of
clinical background can make a diagnosis of dementia
• Assessment (and care) provided at the patient’s home
– Improving Access: Modify memory clinic model
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Referral to Memory Clinics
LOCATION: ENGLAND
– Single point of referral for all memory clinics
– Focus on low referral areas and provide targeted education
– Improved Access: Modification of system
Thomas, H. (2010). "Monitoring referrals to mental health services." Nursing Older People 22(1): 16-22.
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Primary Care Clinic
LOCATION: ENGLAND
– Identification at the primary care clinic
– Assessment at the clinic
– Review by a visiting specialist
– Improving Access: Equipping the Primary Care Clinic (GP) to assess; Specialist visit the clinic (monthly)
Greaves, I. and D. Jolley (2010). "National Dementia Strategy: well intentioned--but how well founded and how well directed?" The British Journal Of General Practice: The Journal Of The Royal College Of General Practitioners 60(572): 193-198.
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Education (Publication)
Boyd, R. (2013). "Early diagnosis and access to treatment for dementia patients." Nurse Prescribing 11(4): 174-178.
LOCATION: ENGLAND– Education for Nurse Prescribers
– Publication in professional journals
– Improving Access: Improving general knowledge
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Education (Pocket Guides)
Horvath, K. J., N. Tumosa, S. Thielke, J. Moorer, T. Huh, S. Cooley, S. Craft and T. Burns (2011). "Dissemination strategies: the evolution of learning resources on the evaluation of delirium, dementia, and depression." Gerontology & Geriatrics Education 32(1): 80-92.
LOCATION: AMERICA
– Target group: Primary care practitioners (doctors, nurses)
– Pocket guide with information on diagnostic process for dementia and delirium
– Evaluation completed
– Improving Access: Improving general knowledge
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Conclusion
Agreement that the diagnostic process is challenging
Different approaches to access– Training for primary care physicians– Education for staff– Support for primary care clinics– Improved access to memory clinics– Revised referral model
Clear evidence of recent focus on improving access