Primary Care Education, Pathways and Research of Dementia (PREPARED): Promoting integrated dementia care through Primary Care Team education

摘要

Introduction : Given the rise in dementia prevalence, primary care dementia workload is inevitably increasing. Caring for people with dementia is demanding and it requires ongoing specialist training (1), yet many health and social care staff in contact with people with dementia in Ireland lack specialist dementia knowledge and are less likely to have received specialist training in comparison to health professionals based in nursing homes (2, 3). The Irish National Dementia Strategy (4) prioritizes the need for dementia specific training to broaden the skills base of primary care health professionals. The overall aim of the Primary Care Education, Pathways and Research of Dementia (PREPARED) program is to deliver and evaluate training, education and support interventions for general practitioners (GPs) and Primary Care Teams (PCTs) that will contribute to patients receiving an integrated, collaborative dementia care response from a prepared, proactive local primary care network. Practice Change : The specific aims of the PCT component of PREPARED are to develop, test and implement a dementia educational workshop for PCTs around collaborative and integrated dementia care. The workshop content is suitable for all primary care clinicians and health professionals who provide care and support to people with dementia and their families in the community. The workshop has been peer reviewed and will be piloted in 2 sites in December and early January 2017, following which it will be rolled out nationally. The training reflects the priorities within the NDS, draws on the principles of the widely used Chronic Care Model (5) and is grounded in the day-to-day needs of patients and PCT members. Successful implementation depends on behaviour change underpinned by increased understanding of dementia and improved outcomes for people with dementia and their families through integrated care practice. The PCT workshop has been developed to achieve change on the basis of an evaluation of current education and support needs among health professionals delivering dementia care within primary care settings. Program Highlights : The impact of the PCT workshop will be evaluated against the following outcomes: (a) increased knowledge of the characteristics of dementia, (b) increased knowledge of how best to support those living with dementia, (c) increased understanding of PCT roles and responsibilities involved in providing integrated dementia care, and (d) increased skill regarding PCT collaboration and inter-professional communication. Researchers from Dublin City University will carry out a comprehensive outcomes and process evaluation of the program guided by the Medical Research Council UK framework for the evaluation of complex interventions (6, 7). Conclusions : The evaluation results will be used to determine level of programme success, why it works and how it can be optimised, and why less successful or unexpected outcomes occurred. Findings will also be used to make recommendations for the subsequent operation and national rollout of the program. The PREPARED PCT Training has the potential to contribute to the impact assessment of collaborative educational interventions on dementia care in Ireland, making it an exemplar for other chronic disease management pathways. References : 1- Brooker D. Person-centred dementia care: making services better. London: Jessica Kingsley Publishers; 2007. 2- de siun A, Manning M. National dementia project: Dementia education needs analysis report. Ireland: Health Service Executive; 2010. 3- Farrell A, Cahill S, Burke S. Rural practice, dementia and CMHN activity. Partnerships in Community Mental Health Nursing and Dementia Care: Practice Perspectives2007. p. 142. 4- Department of Health. The Irish National Dementia Strategy. 2014. 5- Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. Jama. 2002;288(15):1909-14. 6- Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655. 7- Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350:h1258.