Access to personalised dementia care planning in primary care: a mixed methods evaluation of the PriDem intervention

Spencer, Emily; Griffiths, Sarah; Flanagan, Katie; O'Keeffe, Aidan; Wiegand, Martin; Benjamin, Lewis; D'Andrea, Federica; Wilcock, Jane; Poole, Marie; Walters, Kate R; Robinson, Louise; Rait, Greta

Abstract

Objectives: Provision of personalised care planning is a national priority for people with dementia. Research suggests a lack of quality and consistency of care plans and reviews. The PriDem model of care was developed to deliver feasible and acceptable primary care-based post-diagnostic dementia care. We aimed to increase the adoption of personalised care planning for people with dementia, exploring implementation facilitators and barriers. Design: Mixed-methods feasibility and implementation study. Setting: Seven general practices from four Primary Care Networks (PCNs) in the Northeast and Southeast of England. Participants: A medical records audit collected data on 179 community-dwelling people with dementia pre-intervention, and 215 during the intervention year. The qualitative study recruited 26 health and social care professionals, 14 people with dementia and 16 carers linked to participating practices. Intervention: Clinical Dementia Leads (CDL) delivered a 12-month, systems-level intervention in participating PCNs, to develop care systems, build staff capacity and capability, and deliver tailored care and support to people with dementia and their carers. Primary and secondary outcome measures: Adoption of personalised care planning was assessed through a pre- and post-intervention audit of medical records. Implementation barriers and facilitators were explored through semi-structured qualitative interviews and nonparticipant observation, analysed using codebook thematic analysis informed by Normalisation Process Theory. Results: The proportion of personalised care plans increased from 37.4% (95% CI 30.3% to 44.5%) pre-intervention to 64.7% (95% CI 58.3% to 71.0%) in the intervention year. Qualitative findings suggest that the flexible nature of the PriDem intervention enabled staff to overcome contextual barriers through harnessing the skills of the wider multidisciplinary team, delivering increasingly
holistic care to patients. Conclusions: Meaningful personalised care planning can be achieved through a team-based approach. Although improved guidelines for care planning are required, commissioners should consider the benefits of a CDL-led approach.

Citation

Spencer, E., Griffiths, S., Flanagan, K., O'Keeffe, A., Wiegand, M., Benjamin, L., D'Andrea, F., Wilcock, J., Poole, M., Walters, K. R., Robinson, L., & Rait, G. (2024). Access to personalised dementia care planning in primary care: a mixed methods evaluation of the PriDem intervention. BMJ Open, 14(7), Article e082083. https://doi.org/10.1136/bmjopen-2023-082083

• Journal Article Type: Article
• Acceptance Date: Jun 17, 2024
• Online Publication Date: Jul 8, 2024
• Publication Date: 2024-07
• Deposit Date: Jun 27, 2024
• Publicly Available Date: Jun 27, 2024
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Issue: 7
• Article Number: e082083
• DOI: https://doi.org/10.1136/bmjopen-2023-082083
• Public URL: https://nottingham-repository.worktribe.com/output/36570714
• Publisher URL: https://bmjopen.bmj.com/content/14/7/e082083