Implementing dementia risk reduction in primary care: a preliminary conceptual model based on a scoping review of practitioners’ views

Abstract

Primary care practitioners (PCPs) do not routinely promote dementia risk reduction. The purpose of this study was to map the published literature on the views of PCPs about dementia risk reduction, in order to identify implementation constructs and strategies crucial to the development of an implementation intervention to support dementia risk reduction in primary care. We undertook a scoping review of the PCPs’ views about promoting brain health for reducing dementia risk. We searched MEDLINE, PsycINFO, CINAHL, and Embase for English-language articles published between 1995 and December 2017. We then applied the Consolidated Framework for Implementation Research (CFIR) and matched Expert Recommendations for Implementing Change to the scoping review findings in order to develop a preliminary implementation model. Eight articles reported views of PCPs about dementia prevention. Study findings were mapped to 5 of the 39 CFIR constructs: (i) knowledge and beliefs about dementia risk reduction, (ii) evidence strength and quality, (iii) relative priority, (iv) available resources, and (v) external policy and incentives. The findings suggest implementation strategies to consider in our preliminary model include (i) educational meetings, (ii) identifying and preparing champions, (iii) conducting local consensus discussions, (iv) altering incentive structures, and (v) capturing and sharing local knowledge. There have been few studies about the views of PCPs about dementia risk reduction. Implementation in the primary care setting is fundamental to early identification of risk and supporting preventive practices, but it needs to focus on more than just education for PCPs. We need more up-to-date and in-depth data on the views of PCPs about dementia risk reduction and context-specific analyses of implementation needs. Further research into effective primary care interventions to reduce dementia risk is expected to support implementation efforts.

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial

“…On the other hand, we found several determinants associated with implementation success such as Relative Priority, Available Resources, Leadership engagement, and Culture that Martinez et al [56] did not identify. Relative priority is an implementation barrier identi ed in other PHC studies on cognitive health promotion, which found that professionals relegate health promotion activities to a secondary position and prioritise health problems considered more urgent and important for the patient [57][58][59]. Available resources is a commonly perceived barrier by PHC professionals to the integration of health promotion activities into daily practice [11,56].…”

Dementia Risk Reduction in Practice: The Knowledge, Opinions and Perspectives of Australian Healthcare Providers

“…Many resources have been, or are currently in the process of being developed (e.g., 11 ). However, previous research has highlighted that there are difficulties faced with implementing effective educational resources and facilitating practice change in primary care 12, 13 . Travers and colleagues conducted a review of educational and behavioural interventions for risk reduction in primary care and suggested that these approaches are at most, moderately effective 12 .…”

Demenzprävention und hausärztliche Versorgung: Schätzung der Zielpopulation

“…Die Prävention und Strategien der Risiko-Reduktion bei Demenzen [1] geraten zunehmend mehr in das Blickfeld der Versorgungsforschung [2][3][4][5][6]. So haben in einer aktuellen Übersichtsarbeit Escher und Jessen auf die besondere Bedeutung der kardiovaskulären Prävention kognitiver Störungen hingewiesen [7].…”

“…Es ist bekannt, dass Patienten gegenwärtig zunehmend an Demenzprävention interessiert sind [11]. Auch HÄ scheinen bereit zu sein, sich in der Demenzprävention zu engagieren [6], obwohl frühere Erhebungen Gegenteiliges berichteten [12]. So wurden von Hausärzten Bedenken geäußert, ob Demenzprävention überhaupt nützlich sei [13].…”

“…vor der Evidenzgenerierung folgende Fragegestellungen von Interesse: Welche Möglichkeiten ergeben sich durch regulatorische Vorgaben des Gesetzgebers? Wie groß sind die Teilnahmebereitschaften der Hausärzte als Leistungserbringer und die der Patienten als Leistungsempfänger [6]?…”