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The Knowledge Translation Pathway for timely Diagnosis of Dementia. Catherine Travers. PROJECT FOCUS. Service Models Improving access Diagnosis of Dementia. Research Support. Co-Investigators Dr. Melind a Martin-Khan PhD

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project focus
PROJECT FOCUS
  • Service Models
  • Improving access
  • Diagnosis of Dementia
research support
Research Support
  • Co-Investigators

Dr. 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

background when
Background: When …..
  • Diagnosis of dementia:

OPTIONS FOR IDENITFICATION…..

    • Gene testing
    • Risk assessment
    • Early Screening
    • Case finding
    • Review of existing symptoms
background why
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
background why1
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.

background why2
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.

background policy recognition
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.

background the need
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
slide10
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)

method
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
method1
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
referral to memory clinics
Referral to Memory Clinics
  • LOCATION: NETHERLANDS
    • Memory clinics moving away from Tertiary teaching hospitals (increased collaboration with regional care organisations)
  • Usually two or more specialists
  • Referral required to the memory clinic
  • Traditional assessment process
  • Improving Access: Increasing number of clinics

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.

referral to memory clinics1
Referral to Memory Clinics
  • 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

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.

referral to memory clinics2
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.

primary care clinic
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.

education publication
Education (Publication)
  • LOCATION: ENGLAND
    • Education for Nurse Prescribers
    • Publication in professional journals
    • Improving Access: Improving general knowledge

Boyd, R. (2013). "Early diagnosis and access to treatment for dementia patients." Nurse Prescribing 11(4): 174-178.

education pocket guides
Education (Pocket Guides)
  • 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

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.

conclusion
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