Quality assurance as a foundational element for an integrated system of dementia care

Abstract

Purpose Many countries are developing primary care collaborative memory clinics (PCCMCs) to address the rising challenge of dementia. Previous research suggests that quality assurance should be a foundational element of an integrated system of dementia care. The purpose of this paper is to understand physicians’ and specialists’ perspectives on such a system and identify barriers to its implementation. Design/methodology/approach The authors used interviews and a constructivist framework to understand the perspectives on a quality assurance framework for dementia care and barriers to its implementation from ten primary care and ten specialist physicians affiliated with PCCMCs. Findings Interviewees found that the framework reflects quality dementia care, though most could not relate quality assurance to clinical practice. Quality assurance was viewed as an imposition on practitioners rather than as a measure of system integration. Disparities in resources among providers were seen as barriers to quality care. Greater integration with specialists was seen as a potential quality improvement mechanism. Standardized electronic medical records were seen as important to support both quality assurance and clinical care. Practical implications This work identified several challenges to the implementation of a quality assurance framework to support an integrated system of dementia care. Clinicians require education to better understand quality assurance. Additional challenges include inadequate resources, a need for closer collaboration between specialists and PCCMCs, and a need for a standardized electronic medical record. Originality/value Greater health system integration is necessary to provide quality dementia care, and quality assurance could be considered a foundational element driving system integration.

Integrated dementia care: A qualitative evidence synthesis of the experiences of people living with dementia, informal carers and healthcare professionals

“…The 23 included studies were published between 2006 and 2019, with the majority (17) published after 2014. Twelve were conducted in the United Kingdom (Bamford et al, 2014;Bunn et al, 2017;Carter et al, 2017;Davies et al 2014;Gage et al, 2012;Kümpers et al 2006;Kupeli et al, 2016;Piercy et al, 2018;Robertshaw & Cross, 2017;Robertshaw & Cross, 2018;Smith, 2016;Woolrych & Sixsmith, 2013); three in Australia (Bauer et al, 2011;Luckett et al, 2017;Robinson et al, 2009); three in the Netherlands (de Lange et al, 2016;Minkman et al, 2009;van Mierlo et al, 2014); two in Canada (Heckman et al 2019;Kosteniuk et al 2014); two in Japan (Hirakawa et al, 2017;Hirakawa et al, 2019); and one in Spain (Risco et al 2016). Apart from two mixed methods studies (Gage et al, 2012;Piercy et al, 2018), all were qualitative.…”

“…Twelve investigated the experiences and perceptions of health care professionals (e.g. GPs; nurses; social workers), care workers or programme managers (Bamford et al, Carter et al, 2017;Davies et al 2014;de Lange et al, 2016;Gage et al, 2012;Heckman et al 2019;Hirakawa et al, 2017;Hirakawa et al, 2019;Kosteniuk et al, 2014;Kupeli et al, 2016;Luckett et al, 2017;Minkman et al, 2009;Piercy et al, 2018;Smith, 2016;van Mierlo et al, 2014;Woolrych & Sixsmith, 2013); five included a combination of health care professionals and informal carers (Bunn et al, 2017;Kümpers et al 2006;Risco et al 2016;Robertshaw & Cross, 2017;Robertshaw & Cross, 2018) and two exclusively on informal carers (Bauer et al, 2011;Robinson et al, 2009). Three studies also included the perceptions of people living with dementia (Bamford et al, 2014;Bunn et al, 2017;Risco et al 2016).…”

“…To overcome challenges associated with interprofessional communication and collaboration, health and social care services need to be seamlessly joined up, allowing close working relationships between healthcare professionals for integrated care to develop (Bunn et al, 2017;Davies et al 2014;Kosteniuk et al, 2014;Piercy et al, 2018). Some healthcare professionals and specialists were proactively developing working arrangements which promoted collaboration and approaches to integrate care (Heckman et al 2019). Healthcare professionals meeting either face-to-face or via case conferencing to discuss clients' needs has been shown to increase knowledge transfer, improve integrated care and highlighted changing care needs for people living with dementia (Kümpers et al 2006;Luckett et al, 2017;Piercy et al, 2018).…”

“…The importance of developing strong working relationships were also described in other settings, for example, memory clinics. However, a lack of understanding, a perceived poor attitude of some specialists, and GPs having too little time to fully engage in dementia care acted as barriers to adequately integrating care (Heckman et al 2019;Kosteniuk et al, 2014;Minkman et al, 2009;van Mierlo et al, 2014). Some healthcare professionals were reluctant to consult psychiatrists, despite their importance in a community based integrated dementia care system.…”

Improving Primary Health Care for Residents Living in Assisted Living: Evidence for Practice and Policy

“…The systematic collection and analysis of clinical data is key to a fully integrated system. The availability of comprehensive data on the population will help ensure that reforms reflect the needs of the population and facilitate integration of care processes across settings and providers (Heckman et al, 2019). The collection and analysis of comprehensive data to monitor ongoing progress of health reforms will allow for comparisons with other provinces on key indicators.…”