Centre for Research in Geriatric Medicine T HE K NOWLEDGE T RANSLATION P ATHWAY FOR TIMELY D IAGNOSIS OF D EMENTIA Catherine Travers

Centre for Research in Geriatric Medicine


THE KNOWLEDGE TRANSLATION PATHWAY

FOR TIMELY DIAGNOSIS OF DEMENTIA

Catherine Travers


PROJECT FOCUS

Service Models

Improving access

Diagnosis of Dementia


Research Support

Co-InvestigatorsDr. Melinda Martin-Khan PhD

Centre for Research in Geriatric Medicine, The University of Queensland, AUS

Dr. David Lie Older Persons Mental Health, Queensland Health, AUS

Dr. Catherine Travers PhD

Queensland Dementia Training Study Centre (DTSC), Queensland University of Technology, AUS

Financial Support– Dementia Collaborative Research

Centre – Early Detection and Prevention


Background: When …..

Diagnosis of dementia:

OPTIONS FOR IDENITFICATION…..

– Gene testing– Risk assessment– Early Screening– Case finding

– Review of existing symptoms


Background: Why …..

Diagnosis of Dementia– Protracted process– Challenging to diagnosis in the early stages

Delays can occur because– Lack of recognition of early cognitive decline– Limited understanding of any potential benefits of early

recognition of dementia– Delayed access in the diagnostic process


Background: Why…..

Cahill, S., M. Clark, H. O'Connell, B. Lawlor, R. F. Coen and C. Walsh (2008). "The attitudes and practices of general practitioners regarding dementia diagnosis in Ireland." International Journal Of Geriatric Psychiatry 23(7): 663-669.


Background: Why…..

Armari, E., A. Jarmolowicz and P. K. Panegyres (2013). "The needs of patients with early onset dementia." American Journal Of Alzheimer's Disease And Other Dementias 28(1): 42-46.


Background: Policy Recognition…..

International Frameworks for Dementia include:

Public education campaigns to improve public and professional awareness and understanding of dementia

Promotion of early/ timely diagnosis

Increase the workforce to meet the likely increase in demand for services as a result of education

Provide sufficient guidance and support for people with dementia and their carers

Travers, C., D. Lie, L. Halliday and M. Martin-Khan (2012). Towards a National Framework for Dementia Prevention, Promotion and Early Intervention: What are the Options? Report for the Dementia Collaborative Research Centre - Prevention, Early Intervention and Risk Reduction (DCRC-EDP). Brisbane, The University of Queensland.


Background: The need…..

Recognised long gap between when people first seek help and when they finally receive a definitive diagnosis

Focus on improving the support for people who are at the point where they are seeking help


Aim

Identify models of service described in the

published literature which focus on improving access

to a dementia diagnostic process (usually

formal assessment by a specialist or general practitioner)


Method

LITERATURE SEARCH– Medline, PubMed, Cinahl, Health Source: Nursing Academic Edition– Completed November 2013– Excluded: Non-English papers, Publications prior to 1990

INCLUSION/EXCLUSION CRITERIA

INCLUSION EXCLUSION

Reference to Dementia Treatment of Dementia

Diagnostic Diagnostic tool development

Focus on implementation related to timing (interventions improving access)

Epidemiological studies (describing risk profiles or prevalence)

Models of service Barriers or Enablers (Patient specific)

Older adults General mental health services


Method

KEY WORDS– Dementia, and Alzheimer’s Disease (and the dementia sub-types)– Diagnosis (including ‘delayed diagnosis’; ‘early diagnosis’)– Access (‘Health services accessibility’ and ‘Health care access’)– Health Services Research

SEARCH STRATEGY– TWO COMBINATIONS

• (1) Dementia AND Diagnosis AND Access;• (2) Dementia AND Diagnosis AND Health Services Research

• Either 1 OR 2


Method

Centre for Research in Geriatric MedicineCentre for Research in Geriatric Medicine

RESULTS: EXAMPLES OF MODELS OF SERVICE


Referral to Memory Clinics

LOCATION: NETHERLANDS– Memory clinics moving

away from Tertiary teaching hospitals (increased collaboration with regional care organisations)

Ramakers, I. H. G. B. and F. R. J. Verhey (2011). "Development of memory clinics in the Netherlands: 1998 to 2009." Aging & Mental Health 15(1): 34-39.

– Usually two or more specialists– Referral required to the memory clinic– Traditional assessment process– Improving Access: Increasing number of clinics



Banerjee, S., R. Willis, D. Matthews, F. Contell, J. Chan and J. Murray (2007). "Improving the quality of care for mild to moderate dementia: an evaluation of the Croydon Memory Service Model." International Journal Of Geriatric Psychiatry 22(8): 782-788.

LOCATION: ENGLAND– Fast assessment process– Service Model Developed:

Croydon Memory Service Model (CMSM)

• Generic clinical team• All individuals, regardless of

clinical background can make a diagnosis of dementia

• Assessment (and care) provided at the patient’s home

– Improving Access: Modify memory clinic model



LOCATION: ENGLAND

– Single point of referral for all memory clinics

– Focus on low referral areas and provide targeted education

– Improved Access: Modification of system

Thomas, H. (2010). "Monitoring referrals to mental health services." Nursing Older People 22(1): 16-22.


Primary Care Clinic

LOCATION: ENGLAND

– Identification at the primary care clinic

– Assessment at the clinic

– Review by a visiting specialist

– Improving Access: Equipping the Primary Care Clinic (GP) to assess; Specialist visit the clinic (monthly)

Greaves, I. and D. Jolley (2010). "National Dementia Strategy: well intentioned--but how well founded and how well directed?" The British Journal Of General Practice: The Journal Of The Royal College Of General Practitioners 60(572): 193-198.


Education (Publication)

Boyd, R. (2013). "Early diagnosis and access to treatment for dementia patients." Nurse Prescribing 11(4): 174-178.

LOCATION: ENGLAND– Education for Nurse Prescribers

– Publication in professional journals

– Improving Access: Improving general knowledge


Education (Pocket Guides)

Horvath, K. J., N. Tumosa, S. Thielke, J. Moorer, T. Huh, S. Cooley, S. Craft and T. Burns (2011). "Dissemination strategies: the evolution of learning resources on the evaluation of delirium, dementia, and depression." Gerontology & Geriatrics Education 32(1): 80-92.

LOCATION: AMERICA

– Target group: Primary care practitioners (doctors, nurses)

– Pocket guide with information on diagnostic process for dementia and delirium

– Evaluation completed

– Improving Access: Improving general knowledge


Conclusion

Agreement that the diagnostic process is challenging

Different approaches to access– Training for primary care physicians– Education for staff– Support for primary care clinics– Improved access to memory clinics– Revised referral model

Clear evidence of recent focus on improving access


Documents

Centre for Research in Geriatric Medicine T HE K NOWLEDGE T RANSLATION P ATHWAY FOR TIMELY D IAGNOSIS OF D EMENTIA Catherine Travers