Abstract
BackgroundTimely diagnosis of dementia has a wide range of benefits including reduced hospital emergency department presentations, admissions and inpatient length of stay, and improved quality of life for patients and their carers by facilitating access to treatments that reduce symptoms, and allow time to plan for the future. Memory clinics can provide such services, however there is no 'gold standard' model of care. This study involved the co-creation of a model of care for a new multidisciplinary memory clinic with local community members, General Practitioners (GPs), policy-makers, community aged care workers, and service providers.MethodsData collection comprised semi-structured interviews (N = 98) with 20 GPs, and three 2-h community forums involving 53 seniors and community/local government representatives, and 25 community healthcare workers. Interviews and community forums were audio-recorded, transcribed verbatim, and coded by thematic analysis using Quirkos.ResultsGPs’ attitudes towards their role in assessing people with dementia varied. Many GPs reported that they found it useful for patients to have a diagnosis of dementia, but required support from secondary care to make the diagnosis and assist with subsequent management. Community forum participants felt they had a good knowledge of available dementia resources and services, but noted that these were highly fragmented and needed to be easier to navigate for the patient/carer via a 'one-stop-shop' and the provision of a dementia key worker. Expectations for the services and features of a new memory clinic included diagnostic services, rapid referrals, case management, education, legal services, culturally sensitive and appropriate services, allied health, research participation opportunities, and clear communication with GPs. Participants described several barriers to memory clinic utilisation including transportation access, funding, awareness, and costs.ConclusionThis study demonstrates the importance of working with stakeholders to co-design models of care for people with dementia that take into account the local communities’ needs. Findings pave the way for the development of a potential new “gold standard” memory clinic model of care and operationalise new national clinical guidelines.
Highlights
Diagnosis of dementia has a wide range of benefits including reduced hospital emergency department presentations, admissions and inpatient length of stay, and improved quality of life for patients and their carers by facilitating access to treatments that reduce symptoms, and allow time to plan for the future
This is relevant during the symptomatic pre-dementia mild cognitive impairment (MCI) phase which confers significantly increased dementia risk [18, 19], as its classification as a diagnostic entity has been fraught with difficulty due to the lack of a consensus upon clear clinical and research diagnostic and management guidelines; significant efforts have been made to clarify this in recent times [20,21,22]
The General Practitioner (GP) who did not find it useful stated that this was because a diagnosis can be distressing for the patient, or because they felt there was no point given that there is no cure for dementia
Summary
Access to a specialised cognitive assessment service and early diagnosis facilitates: access to treatments which reduce cognitive and neuropsychiatric symptoms [9]; reduces emergency department presentations from residential aged care facilities [10], hospital admissions [11] and length of stay [12, 13]; improves medication adherence and monitoring [11], advance care planning [14], and access to community-based services to support activities of daily living (ADLs); and allows people to stay at home for longer [4, 15]; results in improved mental health for carers [16] and greater acceptance of the diagnosis for both patients and families [17] This is relevant during the symptomatic pre-dementia mild cognitive impairment (MCI) phase which confers significantly increased dementia risk [18, 19], as its classification as a diagnostic entity has been fraught with difficulty due to the lack of a consensus upon clear clinical and research diagnostic and management guidelines; significant efforts have been made to clarify this in recent times [20,21,22]
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