AN ANALYSIS OF PRIMARY CARE ELEMENTS OF INNOVATIVE PERSONALISED, COMMUNITY-BASED SUPPORTS FOR PEOPLE WITH DEMENTIA AND THEIR FAMILIES/CARERS IN IRELAND

Abstract

Dementia is recognised as a public health priority (WHO). Close collaboration and multi-disciplinary team work are best practice in dementia care in the community, however we don't know how this is best done or how to sustain innovative, successful practice. The aim of this research was to (i) explore service providers' descriptions of innovative primary care elements of multidisciplinary community based supports and services for dementia, (ii) examine the extent to which they fit with good practice in other jurisdictions and (iii) identify levers and barriers to the sustainability of these new ways of working. In this qualitative comparative case study, purposeful sampling was employed to recruit community based service providers (n=14) who were involved in innovative dementia services in HSE West and HSE South. Data was generated about structures and processes of the services using semi-structured interviews, and analysed using inductive thematic analysis. Data was examined in relation to the international literature about dementia care by exploring the extent to which these structures and processes fit with good practice in other jurisdictions. The data was also examined in relation to literature about the introduction of innovative service, specifically by drawing on Normalisation Process Theory (NPT). Member checking was used to verify the authenticity of the analysis. (i) The development and implementation of a mobile memory clinic, a GP practice dementia register, multidisciplinary dementia care review meetings and dementia training and education initiatives were described. (ii) The design of these services overall was a good fit with best practice internationally particularly when they intersect with GPs and Primary Care Teams. (iii) Close connections with GPs and Primary Care Teams emerged as a strong lever to successful implementation and sustainability of these innovations. However, over-reliance on time given voluntarily by service providers to drive forward and embed these innovations in practice could serve as a barrier. Innovative services with significant primary care elements that intersect with existing primary care structures and resources are likely to serve an important role in developing a whole community response to dementia.