Medication management for people with dementia in primary care: description of implementation in the DelpHi study

ABSTRACTBackground:Dementia and depression are common syndromes in the elderly. There is lack of knowledge concerning the frequency of depressive symptoms in people with dementia (PWD) and factors associated with depression. The aim of this analysis is to (a) describe the frequency of depressive symptoms in people screened positive for dementia, (b) describe differences between PWD with and without depressive symptoms, and (c) analyze associations between depressive symptoms and other dementia-related variables.Methods:Analyses are based on data of the GP-based intervention trial DelpHi-MV. A sample of 430 (6.29%) people screened positive for dementia in primary care was analyzed regarding depression according to the German version of the Geriatric Depression Scale (GDS, 15-items), demographic variables, and dementia/depression-related variables. Multivariate analyses were conducted to identify factors associated with depressive symptoms.Results:The mean GDS-score of depressive symptoms inn= 430 PWD was m = 3.21 (SD 2.45) with 67 PWD (15.55%) showing clinically relevant depression (GDS < 5) m = 7.71 (SD = 1.92). A total ofn= 72 (16.74%) received a formal diagnosis of depression andn= 62 (14.42%) received antidepressive drug treatment. Depressive symptoms are significantly associated with age (OR = 0.93), functional impairment (OR = 1.36), and quality of life (OR = 0.01, CI: 0.00–0.06).Conclusion:Our results support previous findings that clinically relevant depressive symptoms are more common in people screened positive for dementia than in the general population and are often missed or mismanaged. Our findings underline the importance of managing quality of life, functional status, or depressive symptoms. Also, the results highlight the benefit of including the partner (and probably other carers) for adequate treatment of PWD.

Download Full-text

Barriers and facilitators to the implementation of interventions for medically unexplained symptoms in primary care: A modified Delphi study

Journal of Psychosomatic Research ◽

10.1016/j.jpsychores.2021.110386 ◽

2021 ◽

Vol 143 ◽

pp. 110386

Author(s):

Denise J.C. Hanssen ◽

Anika Ras ◽

Judith G.M. Rosmalen

Keyword(s):

Primary Care ◽

Delphi Study ◽

Medically Unexplained Symptoms ◽

Barriers And Facilitators ◽

Modified Delphi ◽

Medically Unexplained ◽

Unexplained Symptoms

Download Full-text

Outcomes of Primary Care for People With Dementia: What’s Important?

Innovation in Aging ◽

10.1093/geroni/igaa057.533 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 164-165

Author(s):

Laura Wray ◽

Bonnie Vest ◽

Laura Brady ◽

Christina Vair ◽

Gregory Beehler ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Health And Safety ◽

Limited Attention ◽

Veterans Health ◽

Cognitive Screening ◽

Health Administration ◽

People With Dementia ◽

Primary Care Teams ◽

Care Outcomes

Abstract People with dementia (PWD) typically receive most of their healthcare in primary care (PC), but neurocognitive disorders can be challenging to recognize, assess, and manage in that setting. As a result, cognitive impairment in older adults is often missed or not addressed until later stages. The result is poor management of comorbid health conditions, increased healthcare utilization, and negative outcomes for the patient and family. Further, strategies for improvement and barriers to high quality PC for PWD have received limited attention. To improve PC for PWD, it is essential to understand what care outcomes should be targeted. To address this gap, we used a qualitative approach to examine potential outcomes of PC from the perspectives of older adults, family caregivers, primary care teams, and geriatrics specialists (n=79) from two Veterans Health Administration healthcare systems. Participants were interviewed individually or in focus groups. A directed content analysis based on the adapted Donabedian model was employed and expanded to fully capture transcript content. Three main categories of outcomes were identified: Personhood (i.e., independence), Physical Health and Safety, and Quality of Life. Regardless of participant type, respondents focused on similar desired outcomes and, notably, identified outcomes as important for both patients and their broader social context (i.e., caregivers, family). Discussion will: show how findings align with work conducted in specialty and residential care; describe how challenges to attaining these outcomes in PC can be overcome; and, challenge cognitive screening recommendations for PC that are based primarily on risk/benefit analysis of medication-focused outcomes.

Download Full-text

National Competencies for Registered Nurses in Primary Care: A Delphi Study

Western Journal of Nursing Research ◽

10.1177/0193945920935590 ◽

2020 ◽

Vol 42 (12) ◽

pp. 1078-1087

Author(s):

Julia Lukewich ◽

Michelle Allard ◽

Lisa Ashley ◽

Kris Aubrey-Bassler ◽

Denise Bryant-Lukosius ◽

...

Keyword(s):

Primary Care ◽

Registered Nurses ◽

Delphi Study ◽

Delphi Consensus ◽

Care Experience ◽

Role Integration ◽

Partnership Quality ◽

Research Leadership ◽

Team Functioning ◽

Final Round

A Delphi (consensus) process was used to obtain national agreement on competencies for registered nurses (RNs) in primary care. A draft of competencies was developed by key informants. Following this, nurses with primary care experience/expertise completed a Delphi survey to rate the importance of competency statements on a six-point Likert scale. Statements not reaching consensus (agreement ≥80%) were modified and included in a second (final) round. The first survey was completed by 63% ( n = 86/137) of participants and 84% ( n = 72/86) of these participants completed the second survey. Most statements ( n = 45) achieved agreement after the first survey; one statement was dropped and two were combined following the second round. The final list of competencies consists of 47 statements across six domains (professionalism; clinical practice; communication; collaboration and partnership; quality assurance, evaluation, and research; leadership). National competencies will help strengthen the RN workforce within primary care, improve team functioning, and support role integration/optimization.

Download Full-text

Clinical practice guidelines and principles of care for people with dementia: a protocol for undertaking a Delphi technique to identify the recommendations relevant to primary care nurses in the delivery of person-centred dementia care

BMJ Open ◽

10.1136/bmjopen-2020-044843 ◽

2021 ◽

Vol 11 (5) ◽

pp. e044843

Author(s):

Caroline Gibson ◽

Dianne Goeman ◽

Mark William Yates ◽

Dimity Pond

Keyword(s):

Primary Care ◽

General Practice ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Dementia Care ◽

Care Nurse ◽

Primary Care Nurse ◽

People With Dementia ◽

Primary Care Nurses

IntroductionNationally and internationally it is well recognised that dementia is poorly recognised and suboptimally managed in the primary care setting. There are multiple and complex reasons for this gap in care, including a lack of knowledge, high care demands and inadequate time for the general practitioner alone to manage dementia with its multiple physical, psychological and social dimensions. The primary care nurse potentially has a role in assisting the general practitioner in the provision of evidence-based dementia care. Although dementia-care guidelines for general practitioners exist, evidence on resources to support the primary care nurse in dementia care provision is scarce. The ‘Australian Clinical Practice Guidelines and Principles of Care for People with Dementia’ provides 109 recommendations for the diagnosis and management of dementia. This protocol describes a Delphi study to identify which of the 109 recommendations contained in these multidisciplinary guidelines are relevant to the primary care nurse in the delivery of person-centred dementia care in the general practice setting.Methods and analysisUsing a Delphi consensus online survey, an expert panel will grade each of the recommendations written in the ‘Clinical Practice Guidelines and Principles of Care for People with Dementia’ as high-to-low relevance with respect to the role of the primary care nurse in general practice. To optimise reliability of results, quality indicators will be used in the data collection and reporting of the study. Invited panel members will include Australian primary care nurses working in general practice, primary care nursing researchers and representatives of the Australian Primary Health Care Nurses Association, the peak professional body for nurses working in primary healthcare.Ethics and disseminationThis study has been approved by The University of Newcastle Human Research Ethics Committee (HREC) (H-2019-0029).Findings will be published in a peer-reviewed journal and presented at scientific conferences.

Download Full-text

Factors influencing general practitioners’ perception of and attitude towards dementia diagnostics and care—results of a survey among primary care physicians in Germany

Wiener Medizinische Wochenschrift ◽

10.1007/s10354-020-00803-9 ◽

2021 ◽

Author(s):

Julian Wangler ◽

Michael Jansky

Keyword(s):

Primary Care ◽

Influencing Factors ◽

General Practitioners ◽

Primary Care Physicians ◽

Descriptive Analysis ◽

Linear Regression Analysis ◽

Interdisciplinary Cooperation ◽

Practice Staff ◽

People With Dementia ◽

Dementia Diagnostics

SummaryStudies have shown that primary care is not always effective when it comes to caring for people with dementia. In addition, general practitioners do not always use diagnostic instruments consistently. The aim of the study was to identify relevant factors that influence general practitioners’ attitudes and willingness with respect to consistent diagnosis and care. For this purpose, resources, viewpoints, and behavioral patterns of general practitioners with regard to dementia diagnostics as well as common challenges in everyday practice were recorded. In the course of a survey, a total of 2266 general practitioners in Hesse and Baden-Württemberg were interviewed between January and March 2020. In addition to the descriptive analysis, a t-test was used to determine significant differences between two groups. A univariate linear regression analysis was carried out to identify possible influencing factors. 81% of the respondents do provide dementia diagnostics; 51% are involved in the treatment. Most of them see the diagnostic work-up (77%), communication and compliance problems (73%), as well as the therapeutic support (71%) as common challenges. In addition, there are interface problems regarding the interdisciplinary cooperation. Some of the respondents express doubts about the value of early detection (41%). The general practitioners’ attitude with respect to dementia diagnostics and care is determined by influencing factors that relate to geriatric competencies, expectations of self-efficacy, the integration of practice staff, as well as the knowledge of and cooperation with counseling and care services. It seems advisable to strengthen the geriatric competence of general practitioners. Moreover, it appears essential to educate general practitioners more about support structures in the field of dementia care and to integrate them accordingly. In addition, practice staff should be more systematically involved in the identification and care of dementia patients.

Download Full-text

Effectiveness of a Primary Care Program to Increase Physical Activity in People With Dementia and Their Family Caregivers (AFISDEMYF Study).

10.21203/rs.3.rs-1058583/v1 ◽

2021 ◽

Author(s):

Elena DE DIOS-RODRIGUEZ ◽

María C PATINO-ALONSO ◽

Susana GONZÁLEZ-SÁNCHEZ ◽

Joana RIPOLL ◽

Olaya TAMAYO-MORALES ◽

...

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Primary Care ◽

Systolic Blood Pressure ◽

Family Caregivers ◽

Intervention Group ◽

Care Program ◽

Control Group ◽

People With Dementia ◽

The Family

Abstract Aim: To evaluate the effectiveness of an intervention in primary health care designed to increase physical activity in people with dementia and their family caregivers.Methods: A cluster-randomized multicentre clinical trial was carried out.Participants: 140 people with dementia (median age 82 years;63.6% women) and 176 caregivers (median age 62 years ;72.7% women). Seventy patients and 80 caregivers were assigned to the Control Group (CG) and 70 patients and 96 caregivers to the Intervention Group (IG). The physical activity was measured with the pedometer and with the IPAQ-SF questionnaire. The intervention consisted of applying in primary care the program promoting physical activity (PEPAF) for 3 months. The changes observed at 6 months were analyzed. Results:In people with dementia, in the pedometer assessment a decrease was observed in both groups, but it was larger in the CG both in the total number step/day lower in the IG than in the CG and in the aerobic steps / day (52.89 vs -615.93). The activity reported with the IPAQ-SF decreased more in IG, both in the MET/min/week (-258.470 vs -148.23) and in the MVPA min/week. In caregivers the pedometer assessment showed that total steps/day increased more in the IG, as did aerobic steps/day (356.91 vs -12.95). The IPAQ-SF a smaller increase in global activity was declared in the IG than in the CG (545.25 MET/min/week vs 609.55), but the increase in vigorous activity was greater. No differences were found in changes in the functional status and the cognitive performances of people with dementia nor in the mental health in the caregivers, but systolic blood pressure, the Family APGAR and overload in the IG did improve.Conclusions: The results suggest that the intervention carried out may be effective on physical activity in both patients and caregivers. It can also improve systolic blood pressure, the Family APGAR and overload in caregivers. This is the first study to implement a primary care intervention aimed at simultaneously increasing physical activity in people with dementia and their relatives. These results reinforce the importance of using objective measures in clinical trials in people with dementia.Trial registration number: NCT 02044887.

Download Full-text