Importing implementation methods in clinical dementia research

Abstract

AbstractBackgroundBringing clinical innovation from dementia research to health‐care requires implementing new courses of action. Implementation science methods can help bridge the gap between biomedical research and clinical practice. We imported implementation methods to perform a feasibility analysis for implementing the clinician’s Uniform Dataset‐cUDS as a standard cognitive assessment in two contexts: European academic memory clinics and Italian academic and non‐academic memory clinics.Method33 questions, addressing centers' contextual factors, mechanisms of impact, acceptability, hurdles and facilitators were posed to academic and non‐academic memory clinics. The Process Evaluation framework was used as a guidance to evaluate implementation feasibility. Mixed‐methods analyses were performed with SPSS and MAXQDA. We labelled open answers into categories and performed proportion tests for each hurdle and facilitator in both contexts.Result46 EADC (European Alzheimer’s' Disease Consortium) academic and 62 SINDem (Italian Society of Neurology on Dementia)(30 academic, 32 non‐academic) clinicians answered the survey. Acceptability towards implementation of cUDS was 65% among EADC and 95% among SINDem responders (p = .134,ɑ = .05). A statistically significant (p = .01) proportion of SINDem clinicians (47%) reported to envision no barrier to the implementation, as compared to EADC clinicians (11%). 59% of EADC centers reported to receive full reimbursement for cognitive assessment versus only 10% in Italian academic centers(p = .58). Qualitative analysis showed similar barriers as the unavailability of material (e.g., local norms) and finances (e.g., insurance, salary) in both EADC‐SINDem centers. Despite non‐statistical significant differences, compared to EADC, SINDem clinicians showed a trend towards greater need of neuropsychologists/specialized staff (EADC: 6%; SINDem: 14‐25%),in particular among non‐academic centers. On the other hand, EADC clinicians seemed more concerned with logistics (EADC: 15%; SINDem: 3%).ConclusionOur analysis revealed a good level of feasibility and acceptability for cUDS in Europe, especially in Italy which has no prior local standard as compared to other European countries (e.g., Germany, Netherlands). Similar barriers were identified among Europe and Italy, however, facilitators seemed to be more specific of the country and setting of implementation. This data also revealed structural hurdles, like heterogeneous reimbursement levels for cognitive assessment. Overall, country‐based feasibility analysis are necessary before proceeding into implementation.