Transforming health care in nursing homes. An evaluation of a dedicated primary care service in outer east London | Nuffield Trust
The Nuffield Trust was commissioned by the Barking and Dagenham, Havering and Redbridge Clinical Commissioning Groups to evaluate a new primary care service that was being piloted in four nursing homes in the London Borough of Havering that had previously had difficulty accessing GP services.
The service’s main features were the assignment of a single GP practice to all residents; access to health care professionals with expertise in caring for older people with complex needs; extended access beyond normal GP hours; care guidance to nursing home staff; improved medicines management; and new approaches for managing people who are at the end of life.
The evaluation suggests that there are benefits in providing proactive primary care for nursing homes, delivered by a consistent GP within a service that specialises in older people with complex care needs.
This report assesses the impact of the new service on hospital attendance, and details the experiences and views of staff in the nursing homes and health care professionals delivering the new service.
This related article from the Guardian reports on the success of the £400,000 pilot scheme in which a dedicated primary care practice provides 431 residents of care homes with 8am to 8pm, seven-days-a-week GP support.
Despite having complex needs, most of the healthcare received by people in the later stages of dementia is provided by GPs or emergency services, with little support from specialist healthcare professionals. | via Marie Curie
Researchers, from the Marie Curie Palliative Care Research Department at University College London, found that GPs were the main providers of medical care, with 96% of people with advanced dementia seeing a GP in their last month of life. Paramedics also played a major role in assessment and healthcare towards the end of life, suggesting a reactive rather than planned response to patients’ needs – nearly one in five (19%) were seen by a paramedic in the month prior to their death.
Only 1% of people with advanced dementia were seen during the follow up period of the study by a geriatrician or an older persons’ psychiatrist.
Based on the findings, the researchers say that healthcare services are not currently tailored to the complex needs and symptoms of people with advanced dementia. Given that dementia is now the leading cause of death, they say there is urgent need to ensure an adequate standard of comfort and quality of life for patients.
General practitioners (GPs) play a major role in the assessment of dementia but it is still unrecognized in primary care and its management is heterogeneous | Aging & Mental Health
Objective: Our objective is to describe the usual practices, and their determinants, of French GPs in this field.
Results: Hundred two GPs completed the study. GPs were in majority men, working in urban areas. Mean age was 54.4 years old. GPs’ feeling of confidence and self-perception of follow-up of national recommendations is linked with their practices. Performing a clinical interview to assess cognitive impairment is linked with good communication skills. GPs feel less confident to give information about resources for dementia. The main reason alleged for underdiagnosis is the limited effectiveness of drug therapy.
Conclusions: This study underlines the importance of GPs’ feeling of confidence when managing cognitively impaired patients with dementia, and the need of increasing training in the field of dementia, which could improve the awareness of GPs about diagnosis and available resources.
DeAR-GP (Dementia Assessment Referral to GP) | Health Innovation Network | Alzheimer’s Society
DeAR–GP, developed by the Health Innovation Network and supported by Alzheimer’s Society, is a simple paper based case-finding tool which has been designed for use by care workers to identify people who are showing signs of dementia or confusion and refer them to their GP or healthcare professional for review.
Once completed, DeAR-GP acts as a communication aide between care workers and GPs and supports NICE ‘Dementia: support in health and social care’ (QS1) quality statement 2: ‘People with suspected dementia are referred to a memory assessment service’.
A diagnosis will aid the understanding of care workers and family members and friends; leading to better care and support of the person with dementia.
The National Clinical Director for Dementia, Professor Alistair Burns has been writing to CCGs with the national dementia diagnosis rate in order to achieve and maintain the national ambition of diagnosing 2/3rd of the estimated population living with dementia.
The monthly CCG letters can be found below with the national dementia diagnosis rates alongside general updates on national priorities. Commissioners are asked to cascade this information to member practices.
Objectives: To identify general practitioners’ (GPs) knowledge, practices, and obstacles with regard to the diagnosis and management of dementia.
Methods: Standardized questionnaires covering knowledge, practices, and obstacles were distributed among a purposive sample of GPs in Kathmandu, Nepal. Three hundred and eighty GPs responded (response rate = 89%).
Results: Knowledge of practitioners’ with regard to the diagnosis and management of dementia was unsatisfactory (<50%). Diagnosis and management barriers are presented with regard to GP, patient, and carer factors. Specifically, the results address the following issues: communicating the diagnosis, negative views of dementia, difficulty diagnosing early-stage dementia, acceptability of specialists, responsibility for extra issues, knowledge of dementia and aging, less awareness of declining abilities, diminished resources to handle care, lack of specific guidelines, and poor awareness of epidemiology.
Conclusions: Demographic changes mean that dementia will represent a significant problem in the future. The following paper outlines the problems and solutions that the Nepalese medical community needs to adopt to deal effectively with diagnosis, care, and management of dementia.