Bunn Frances, Burn Anne-Marie, Robinson Louise, Poole Marie, Rait Greta, Brayne Carol, Schoeman Johan, Norton Sam, Goodman Claire
Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK.
Institute for Health and Society, Newcastle University, Newcastle, UK.
BMJ Open. 2017 Jan 18;7(1):e013067. doi: 10.1136/bmjopen-2016-013067.
People living with dementia (PLWD) have a high prevalence of comorbidty. The aim of this study was to explore the impact of dementia on access to non-dementia services and identify ways of improving service delivery for this population.
Qualitative study involving interviews and focus groups. Thematic content analysis was informed by theories of continuity of care and access to care.
Primary and secondary care in the South and North East of England.
PLWD who had 1 of the following comorbidities-diabetes, stroke, vision impairment, their family carers and healthcare professionals (HCPs) in the 3 conditions.
We recruited 28 community-dwelling PLWD, 33 family carers and 56 HCPs. Analysis resulted in 3 overarching themes: (1) family carers facilitate access to care and continuity of care, (2) the impact of the severity and presentation of dementia on management of comorbid conditions, (3) communication and collaboration across specialities and services is not dementia aware. We found examples of good practice, but these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD.
This study suggests that, in order to improve access and continuity for PLWD and comorbidity, a significant change in the organisation of care is required which involves: coproduction of care where professionals, PLWD and family carers work in partnership; recognition of the way a patient's diagnosis of dementia affects the management of other long-term conditions; flexibility in services to ensure they are sensitive to the changing needs of PLWD and their family carers over time; and improved collaboration across specialities and organisations. Research is needed to develop interventions that support partnership working and tailoring of care for PLWD and comorbidity.
痴呆症患者（PLWD）合并症的患病率很高。本研究的目的是探讨痴呆症对获得非痴呆症服务的影响，并确定改善该人群服务提供的方法。
采用访谈和焦点小组的定性研究。主题内容分析以护理连续性和获得护理的理论为依据。
英格兰南部和东北部的初级和二级护理机构。
患有以下合并症之一的痴呆症患者——糖尿病、中风、视力障碍，他们的家庭护理人员以及这三种情况下的医疗保健专业人员（HCPs）。
我们招募了28名社区居住的痴呆症患者、33名家庭护理人员和56名医疗保健专业人员。分析得出三个总体主题：（1）家庭护理人员促进了护理的获得和护理的连续性；（2）痴呆症的严重程度和表现对合并症管理的影响；（3）各专科和服务之间的沟通与协作没有考虑到痴呆症因素。我们发现了一些良好做法的例子，但这些往往是关于个体从业者的行为，而不是基于系统的方法；当前的系统可能无意中阻碍了痴呆症患者获得护理。
本研究表明，为了改善痴呆症患者及其合并症的护理可及性和连续性，需要对护理组织进行重大变革，这包括：护理的共同生产，即专业人员、痴呆症患者和家庭护理人员合作；认识到患者的痴呆症诊断对其他长期病症管理的影响方式；服务的灵活性，以确保随着时间的推移，它们能对痴呆症患者及其家庭护理人员不断变化的需求保持敏感；以及改善各专科和组织之间的协作。需要开展研究，以开发支持合作工作和为痴呆症患者及其合并症量身定制护理的干预措施。
