Abstract
BackgroundNon-pharmacological interventions including physical activity programmes, occupational therapy and caregiver education programmes have been shown to lead to better outcomes for people with dementia and their care partners. Yet, there are gaps between what is recommended in guidelines and what happens in practice. The aim of this study was to bring together clinicians working in dementia care and establish a quality improvement collaborative. The aim of the quality improvement collaborative was to increase self-reported guideline adherence to three guideline recommendations.MethodsInterrupted time series. We recruited health professionals from community, hospital and aged care settings across Australia to join the collaborative. Members of the collaborative participated in a start-up meeting, completed an online learning course with clinical and quality improvement content, formed a quality improvement plan which was reviewed by a team of experts, received feedback following an audit of their current practice and were able to share experiences with their peers. The primary outcome was self-reported adherence to their guideline recommendation of interest which was measured using checklists. Data were collected monthly over a period of 18 months, and the study used an interrupted time series design and multilevel Poisson regression analysis to evaluate changes in self-reported adherence.ResultsA total of 45 health professionals (78% therapists) from different sites joined the collaborative and 28 completed all requirements. Data from 1717 checklists were included in the analyses. Over the duration of the project, there was a significant increase in clinician self-reported adherence to guideline recommendations with a 42.1% immediate increase in adherence (incidence rate ratio = 1.42; 95% confidence interval = 1.08–1.87; p = 0.012).ConclusionHealth professionals working with people with dementia are interested in and willing to join a quality improvement collaborative with the goal of improving non-pharmacological aspects of care. Participation in the collaborative improved the quality of care for people with dementia as measured through self-reported adherence to guideline recommendations. Although there are challenges in implementation of guideline recommendations within dementia care, the quality improvement collaborative method was considered successful. A strength was that it equipped and empowered clinicians to lead improvement activities and allowed for heterogeneity in terms of service and setting.Trial registrationACTRN12618000268246
Highlights
Non-pharmacological interventions including physical activity programmes, occupational therapy and caregiver education programmes have been shown to lead to better outcomes for people with dementia and their care partners
This paper addresses the following research questions: 1. Can the establishment of a national quality improvement collaborative of health professionals increase self-reported adherence to three recommendations from clinical practice guidelines for dementia? If so, are increases sustained over the following months? 2
Most clinicians (n = 40, 89%) were female and worked on average 0.8 fulltime equivalent (FTE) which equates to approximately 30 h per week
Summary
Non-pharmacological interventions including physical activity programmes, occupational therapy and caregiver education programmes have been shown to lead to better outcomes for people with dementia and their care partners. Despite an increasing volume of high-quality dementia research, there is limited awareness of effective evidence-based treatments for people with dementia [3]. The development of clinical practice guidelines for dementia has aimed to increase awareness of the evidence and subsequently improve the quality and consistency of dementia care [6, 7]. As described by Glasziou and colleagues [8], health professionals in the field must be aware of and accept guideline recommendations. They must believe that guideline recommendations are applicable to their workplace and they must be able to implement recommendations within existing resources. They must disrupt the status quo and take action to implement changes
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