Abstract
BackgroundThe need to better understand implementing evidence-informed dementia care has been recognised in multiple priority-setting partnerships. The aim of this scoping review was to give an overview of the state of the evidence on implementation and dissemination of dementia care, and create a systematic evidence map.MethodsWe sought studies that addressed dissemination and implementation strategies or described barriers and facilitators to implementation across dementia stages and care settings. Twelve databases were searched from inception to October 2015 followed by forward citation and grey literature searches. Quantitative studies with a comparative research design and qualitative studies with recognised methods of data collection were included. Titles, abstracts and full texts were screened independently by two reviewers with discrepancies resolved by a third where necessary. Data extraction was performed by one reviewer and checked by a second. Strategies were mapped according to the ERIC compilation.ResultsEighty-eight studies were included (30 quantitative, 34 qualitative and 24 mixed-methods studies). Approximately 60% of studies reported implementation strategies to improve practice: training and education of professionals (94%), promotion of stakeholder interrelationships (69%) and evaluative strategies (46%) were common; financial strategies were rare (15%). Nearly 70% of studies reported barriers or facilitators of care practices primarily within residential care settings. Organisational factors, including time constraints and increased workload, were recurrent barriers, whereas leadership and managerial support were often reported to promote implementation. Less is known about implementation activities in primary care and hospital settings, or the views and experiences of people with dementia and their family caregivers.ConclusionThis scoping review and mapping of the evidence reveals a paucity of robust evidence to inform the successful dissemination and implementation of evidence-based dementia care. Further exploration of the most appropriate methods to evaluate and report initiatives to bring about change and of the effectiveness of implementation strategies is necessary if we are to make changes in practice that improve dementia care.
Highlights
The need to better understand implementing evidence-informed dementia care has been recognised in multiple priority-setting partnerships
Consent to publish Not applicable. This scoping review and systematic mapping of the evidence reveals a paucity of robust evidence to inform the successful dissemination and implementation of evidence-based dementia care
Noteworthy gaps in the evidence include research to inform effective methods of dissemination and implementation in hospital and primary care settings, and to support people with dementia and their carers living in the community
Summary
The need to better understand implementing evidence-informed dementia care has been recognised in multiple priority-setting partnerships. Dementia is among the most feared conditions in adults aged over 55 [3] and poses a significant economic burden to individuals and healthcare systems with average annual costs over €160 billion in Europe and $150 billion in the US [4, 5] Perhaps because of this growing cost, dementia has come increasingly to the attention of policymakers (e.g. Department of Health 2015 [6], US Department of Health and Human Services 2016 [7]) who have highlighted the need for more research on prevention, care, and cure as well as for high quality service provision. In the US, the Dementia Action Alliance found that “dementia care in this country is impersonal and fragmented” [10] and the privately-funded Alzheimer’s Australia National Quality Dementia Care Initiative was explicitly established “to fast-track the implementation of existing dementia care research into wide-spread improvements in practice” [11]
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