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Dementia care management in primary care

Current collaborative care models and the case for interprofessional education

Versorgungsmanagement bei Demenz in der Primärversorgung

Aktuelle kooperative Versorgungsmodelle und der Vorteil von interprofessionellem Lernen

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Abstract

Background

Dementia is one of the most prevalent diseases in the older population. Various dementia care models have been developed to address patient’s healthcare needs. They can be described as “collaborative care” or “person-centered care”. Referring to the needs of the workforce working with persons with dementia, a key element is the use of interprofessional education (IPE).

Objective

The purpose of this article is to describe different international collaborative care models to define a minimum standard of healthcare professions for collaborative dementia care in primary care. This helps to identify requirements for IPE to optimize care of people with dementia and to support informal caregivers in the future.

Material and methods

In this article six dementia care models from 4 different countries (Germany, USA, UK and Netherlands) are described and compared regarding aims, interventions and healthcare professionals involved.

Results

Care teams are minimally comprised of general practitioners or primary care providers, nurses, and social workers. Additional healthcare disciplines may be involved for specific interventions. Mostly, care team members received specific training but such training did not necessarily incorporate the IPE approach. To ensure successful collaboration of professions, IPE training programs should at least consist of the following core topics: (1) early diagnosis, (2) postdiagnostic support, (3) advanced care planning for patients and caregivers and (4) effective collaborative care.

Conclusion

The IPE programs for dementia should be expanded and must be widely implemented in order to assess the impact on collaborative practice. This study will provide the knowledge base for structuring IPE trainings developing educational agendas and adapting existing guidelines to improve collaborative dementia care in the future.

Zusammenfassung

Hintergrund

Demenz ist eine der häufigsten Erkrankungen im höheren Alter und erfordert innovative Konzepte zur Versorgung der Betroffenen. Um Gesundheitsberufe adäquat auf eine patientenzentrierte, interprofessionelle Demenzversorgung vorzubereiten hat sich das interprofessionelle Lernen (IPL) bewährt.

Ziel der Arbeit

Ziel ist es, Versorgungskonzepte für Menschen mit Demenz zu beschreiben und einen Mindeststandard an Professionen zu definieren, die an der patientenzentrierten Demenzversorgung beteiligt werden sollten, sowie Erfordernisse an das IPL zu identifizieren.

Material und Methoden

Sechs Versorgungskonzepte aus 4 Ländern (Deutschland, USA, Großbritannien, Niederlande) werden hinsichtlich ihrer Ziele, Interventionen und involvierten Gesundheitsfachberufe verglichen, um Rückschlüsse für das IPL zu ziehen.

Ergebnisse

Hausärzte, Pflegefachpersonen und Sozialarbeiter sind in allen Ländern Teil des Versorgungsteams. Weitere Gesundheitsberufe werden für spezifische Interventionen einbezogen. Die Mitglieder des Versorgungsteams werden zumeist speziell qualifiziert, jedoch nicht im interprofessionellen Lernansatz. IPL Qualifikationen sollten mindestens folgende Themenbereiche umfassen: (1) frühe Diagnostik, (2) Versorgung nach Diagnosestellung, (3) effektives Versorgungsmanagement und (4) interprofessionelle Zusammenarbeit.

Diskussion

IPL sollte künftig für das Krankheitsbild Demenz ausgeweitet sowie weitreichend implementiert und evaluiert werden, um den Nutzen für die interprofessionelle Teamarbeit in der Praxis zu überprüfen. Dies ist die Basis, um länderspezifische IPL Bildungsprogramme zu entwickeln und bestehende Versorgungsleitlinien für eine verbesserte interprofessionelle Demenzversorgung im ambulanten Setting anzupassen.

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Acknowledgements

The DelpHi trial was developed and established as a result of input from the following experts in their respective fields: Aniela Angelow, Grit Aßmann, Georgia Böwing, Thomas Fiß, Daniel Fredrich, Leonore Köhler, and Steffen Richter. An experienced field study team provided support with data collection and data management: Ines Abraham, Kerstin Albuerne, Vaska Böhmann, Kathleen Dittmer, Sarah Gardzella, Jana Hubert, Ulrike Kempe, Viktoriya Kim, Julius Krause, Andrea Pooch, Saskia Moll, Sabine Schmidt, and Christine Winckler. The authors thank all participating patients and their general practitioners for their most valued collaboration. The study is funded by the German Center for Neurodegenerative Diseases (DZNE) and the University Medicine Greifswald. Dr. Guerriero Austrom was supported in part by NIA Grant No. P30AG10133.

Author information

Authors and Affiliations

  1. Institute for Community Medicine, Dept. Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany

    Adina Dreier-Wolfgramm M.Sc., Dipl.-Pflegewirtin (FH) & Wolfgang Hoffmann

  2. German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany

    Bernhard Michalowsky, Jochen René Thyrian, Diana Wucherer, Ina Zwingmann & Wolfgang Hoffmann

  3. Department of Psychiatry, Indiana Alzheimer Disease Center, Indiana University Center for Aging Research (IU-CAR), Indiana University School of Medicine (IUSM), Indianapolis, USA

    Mary Guerriero Austrom

  4. Radboud Institute for Health Sciences, Department of Geriatric Medicine/Radboudumc Alzheimer Centre, Radboud university medical centre, Nijmegen, Netherlands

    Marjolein A. van der Marck

  5. Research Department of Primary Care & Population Health, University College London, London, UK

    Steve Iliffe

  6. USA Regenstrief Institute, Inc., Eskenazi Health, Indianapolis, USA

    Catherine Alder

  7. Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany

    Horst Christian Vollmar

  8. Institute of General Practice and Family Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany

    Horst Christian Vollmar

Authors
  1. Adina Dreier-Wolfgramm M.Sc., Dipl.-Pflegewirtin (FH)
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  2. Bernhard Michalowsky
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  5. Steve Iliffe
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  6. Catherine Alder
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  8. Jochen René Thyrian
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  9. Diana Wucherer
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  10. Ina Zwingmann
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  11. Wolfgang Hoffmann
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Corresponding author

Correspondence to Adina Dreier-Wolfgramm M.Sc., Dipl.-Pflegewirtin (FH).

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Conflict of interests

A. Dreier-Wolfgramm, B. Michalowsky, M.G. Austrom, M.A. van der Marck, S. Iliffe, C. Alder, H.C. Vollmar, J.R. Thyrian, D. Wucherer, I. Zwingmann and W. Hoffmann declare that they have no competing interests.

All procedures of the six described studies were in accordance with the ethical standards of the responsible ethics committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version). Informed consent was obtained from all individual participants included in the study.

The supplement containing this article is not sponsored by industry.

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Dreier-Wolfgramm, A., Michalowsky, B., Austrom, M.G. et al. Dementia care management in primary care. Z Gerontol Geriat 50 (Suppl 2), 68–77 (2017). https://doi.org/10.1007/s00391-017-1220-8

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  • DOI: https://doi.org/10.1007/s00391-017-1220-8

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