Designing a complex intervention for dementia case management in primary care

Abstract

BackgroundCommunity-based support will become increasingly important for people with dementia, but currently services are fragmented and the quality of care is variable. Case management is a popular approach to care co-ordination, but evidence to date on its effectiveness in dementia has been equivocal. Case management interventions need to be designed to overcome obstacles to care co-ordination and maximise benefit. A successful case management methodology was adapted from the United States (US) version for use in English primary care, with a view to a definitive trial. Medical Research Council guidance on the development of complex interventions was implemented in the adaptation process, to capture the skill sets, person characteristics and learning needs of primary care based case managers.MethodsCo-design of the case manager role in a single NHS provider organisation, with external peer review by professionals and carers, in an iterative technology development process.ResultsThe generic skills and personal attributes were described for practice nurses taking up the case manager role in their workplaces, and for social workers seconded to general practice teams, together with a method of assessing their learning needs. A manual of information material for people with dementia and their family carers was also created using the US intervention as its source.ConclusionsCo-design produces rich products that have face validity and map onto the complexities of dementia and of health and care services. The feasibility of the case manager role, as described and defined by this process, needs evaluation in ‘real life’ settings.

The effectiveness of collaborative care for people with memory problems in primary care: results of the CAREDEM case management modelling and feasibility study

“…53 WP1 was designed to review, adapt and customise the PREVENT intervention 30 for implementation in the CAREDEM study within NHS general practice. Development of WP1 took place in the area covered by Kent and Medway NHS and Social Care Partnership Trust.…”

Introducing case management for people with dementia in primary care: a mixed-methods study

“…The cultural adaptation of the PREVENT intervention followed an experiencebased design approach, 24 and is described elsewhere. 25 It was underpinned by diffusion science, 26 which describes how uptake of an innovation is determined by its compatibility with the values, norms, and perceived needs of practitioners, ease of use, clear, unambiguous effectiveness or cost-effectiveness, testability in practice, adaptability to fit local circumstances, likely benefit to the user's social approval, and lack of compulsion. 27,28 …”

„Aging Brain Care Program“ aus Indianapolis

“…Auch in Deutschland existieren Forschungsprojekte für die strukturierte Versorgung von älteren Menschen mit chronischen Krankheiten u. a. ebenfalls mit demenziellen Erkrankungen [15,18,20,27,30]. An dieser Stelle werden nur 2 exemplarisch genannt, die im Rahmen von randomisierten kontrollierten Studien evaluiert wurden bzw.…”

“…In vielen Programmen, insbesondere international, erfolgt die Versorgung älte-rer Menschen mit Demenz und/oder Depression in multiprofessionellen Teams, die Betroffene auch in ihrer Häuslich-keit aufsuchen [12,18,20,22,30]. Studien konnten zeigen, dass einige dieser Programme zu einer besseren Versorgungsqualität bei Menschen mit chronischen Erkrankungen führen [8,13,21,28].…”