Abstract
BackgroundCommunity-based support will become increasingly important for people with dementia, but currently services are fragmented and the quality of care is variable. Case management is a popular approach to care co-ordination, but evidence to date on its effectiveness in dementia has been equivocal. Case management interventions need to be designed to overcome obstacles to care co-ordination and maximise benefit. A successful case management methodology was adapted from the United States (US) version for use in English primary care, with a view to a definitive trial. Medical Research Council guidance on the development of complex interventions was implemented in the adaptation process, to capture the skill sets, person characteristics and learning needs of primary care based case managers.MethodsCo-design of the case manager role in a single NHS provider organisation, with external peer review by professionals and carers, in an iterative technology development process.ResultsThe generic skills and personal attributes were described for practice nurses taking up the case manager role in their workplaces, and for social workers seconded to general practice teams, together with a method of assessing their learning needs. A manual of information material for people with dementia and their family carers was also created using the US intervention as its source.ConclusionsCo-design produces rich products that have face validity and map onto the complexities of dementia and of health and care services. The feasibility of the case manager role, as described and defined by this process, needs evaluation in ‘real life’ settings.
Highlights
Community-based support will become increasingly important for people with dementia, but currently services are fragmented and the quality of care is variable
In response to this review, we argued that a detailed specification of the sorts of activities to be included in case management was needed, with an understanding of how case managers might tailor their support to the needs of the person with dementia and their family [14]
The aim of this paper is to report and discuss the adaptation of the PREVENT intervention to the setting of the English National Health Service (NHS) and local government Adult Services, by practitioners and people with experiences of dementia services
Summary
Community-based support will become increasingly important for people with dementia, but currently services are fragmented and the quality of care is variable. Medical Research Council guidance on the development of complex interventions was implemented in the adaptation process, to capture the skill sets, person characteristics and learning needs of primary care based case managers. In the UK, currently around 700,000 people have dementia but this is estimated to rise to 1 million by 2020 and 1.7 million by 2050, an increase of over 150% [1]. The current costs of caring for people with dementia in the UK have been estimated at between £17 and £18 billion a year. Around two-thirds of people with dementia live at home, with the majority of their care provided by family members with support from primary and social care teams. NICE-SCIE (2006) guidelines recommend that coordinated care led by a single professional should be provided for people with dementia
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