A national dementia care pathway explored and compared

Abstract

AbstractBackgroundA national, systematic diagnosis and care pathway has the potential to alleviate pressing challenges experienced by individuals with dementia, their carers, and healthcare providers. International exemplars were sought to compare/contrast dementia care with current practice in the United States (US). Specifically, the 2013 New Zealand (NZ) Framework for Dementia Care was explored. The aim was to better understand this systematic, primary care‐led, home and community‐focused dementia management approach from the perspective of those delivering care. To better understand its potential for adoption, US providers were similarly studied.MethodMaximum variation purposive sampling was used in this qualitative descriptive study of 28 participants (18 New Zealand, 10 United States) including providers, case managers/social workers and government officials. Following review and approval by the IRB, investigator‐developed semi‐structured interviews were used, with recruitment of participants continuing until data saturation was reached. Data were then explored for themes using qualitative content analysis, the preferred approach for qualitative descriptive design, and supported by HyperResearch. Throughout the study, qualitative research quality enhancement strategies follow the classic approach of Guba and Lincoln (1994).ResultsNational standards in NZ provide a progressive pathway grounded in early primary care diagnoses and adaptable teams that foster caregiver support to decrease their burden (See Figure 1). The approach also ensures streamlined access to specialists by integrating dementia care in primary care. This is in contrast to the US, where a reactive rather than proactive approach requires providers to navigate unpredictability as they strive to weave together insufficient, inadequate, inconsistent, and inequitable resources to cobble a family’s foundation for an uncertain future.ConclusionCompared to the US where only 2.12% of the Medicare spend is on primary care (Bannow, 2019), NZ is grounded in a strong primary care foundation as are many of the world’s most highly functioning health care systems (Schneider, Sarnak, Squires, Shah & Doty, 2017). Individual states exploring total cost care models, do have the capacity to redesign primary care for enhanced capacity for dementia management both within practice and community settings and should take action. Further implications for translating promising practices to the US are detailed.