Abstract
Objectives: In 2012–2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges.
Design: Qualitative study involving interviews, focus groups and thematic content analysis.
Setting: Primary care and secondary care across six counties in the East of England.
Participants: Hospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals.
Results: We recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs’ lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding.
Conclusions: The study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care services across settings.
Design: Qualitative study involving interviews, focus groups and thematic content analysis.
Setting: Primary care and secondary care across six counties in the East of England.
Participants: Hospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals.
Results: We recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs’ lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding.
Conclusions: The study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care services across settings.
Original language | English |
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Article number | e020521 |
Journal | BMJ Open |
Volume | 8 |
Issue number | 3 |
Early online date | 17 Mar 2018 |
DOIs | |
Publication status | Published - Mar 2018 |
Profiles
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Chris Fox
- Norwich Medical School - Honorary Professor
- Institute for Volunteering Research - Member
- Norwich Epidemiology Centre - Member
- Mental Health - Member
Person: Honorary, Research Group Member, Research Centre Member