The benefit of a geriatric nurse practitioner in a multidisciplinary diagnostic service for people with cognitive disorders

Abstract

BackgroundThe aim of the study was to evaluate whether adding a geriatric nurse practitioner (GNP) to an outpatient diagnostic multidisciplinary facility for patients with cognitive disorders (Diagnostic Observation Center for PsychoGeriatry, DOC-PG) could improve quality of care. DOC-PG combines hospital diagnostics and care assessment from a community mental health team and provides the general practitioner (GP) with advice for treatment and management. In a previous study, we found that 28.7% of the advice made by this service was not followed up on by the GP.MethodsTwo cohorts were studied: a group of patients with added GNP (n = 114) and a historical reference sample (n = 137). Both groups followed the same diagnostic protocol and care approach, but, in the GNP group, a care coordinator was added in order to communicate the advice from the DOC-PG to the GP. The primary outcome was the concordance rate of GPs regarding the advice. At the patient level, health-related quality of life (HRQoL) was assessed. Self-Rated Burden and care-related quality of life were measured at the informal caregiver level. Measures were conducted immediately after DOC-PG diagnosis and after 6 and 12 months. Univariate analyses, logistic regression analyses, and mixed model multilevel analyses were used to test differences between both groups.ResultsTotal concordance rates were significantly higher in the GNP group compared to the reference sample (82.1 and 71.3%, respectively; p < 0.001). No improvement in patient HRQoL was identified. Among the informal caregivers, a significant reduction of Self-Rated Burden was found in the GNP group at 12 months (adjusted mean difference −1.724, 95% CI −2.582 to −0.866; p < 0.001).ConclusionsAdding a GNP to an outpatient diagnostic multidisciplinary facility for patients with cognitive disorders may improve the GP concordance rate of the advice from the DOC-PG and reduce subjective burden of the informal caregiver.

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

“…Thus, we suggest that there is an important role for co-ordinated care by a trained dementia practitioner, 346 as there appears to be a skill gap related to the management of dementia and CB in the current workforce. Given our observations on the differing contextual resources required for delivery within care homes and family care settings, a priority for service improvements for effective management of dementia and CB is the development of separate service models for care home and family care settings within which specialist dementia practitioners may be trained and resourced to have clarity of purpose in their goals for patient care and related contextual outcomes.…”

Interventions to enhance access to and utilization of formal community care services for home dwelling persons with dementia and their informal carers. A scoping review

“…Seven publications were randomized controlled trials (Amjad et al, 2018;Donath et al, 2010;Lawton et al, 1989;McCallion et al, 2004;Newcomer et al, 1999;Vickrey et al, 2006;Weinberger et al, 1993). Three were non-randomized controlled trials (Ament et al, 2015;Bass et al, 2013;Romero et al, 2007). Six publications were one-group pretestposttest trials (Aranda et al, 2003;Emme von der Ahe et al, 2011;Emme von der Ahe et al, 2010;Lathren et al, 2013;Lee et al, 2014;Tompkins & Bell, 2009).…”

“…Two of the studies had no effect on relevant outcomes; one was a referral-focused intervention (Ament et al, 2015), the other used monetary support in combination with case management (Lawton et al, 1989) (table 1).…”

How do nurse practitioners work in primary health care settings? A scoping review

“…For example, individuals with diabetes generally experienced reduced HbA1cs (Chang, Davis et al 2007, Stone, MacPherson et al 2010, Choi and Rush 2012, Jessee and Rutledge 2012 while other individuals reported an improvement in symptoms specific to their disease process (Philp, Lucock et al 2006, Wright, Purdy et al 2007, Owens, Eby et al 2012, Sawatzky, Christie et al 2013, Voorn, Vermeulen et al 2013, Housholder-Hughes, Ranella et al 2015, Kozlowski, Lusk et al 2015, Teunissen, Stegeman et al 2015. In some studies caregivers also benefitted from the nurse practitioner intervention, such as caregivers of patients with dementia who reported a reduced caregiver burden (Ament, Wolfs et al 2015).…”