Primary Care and Population Health, UCL, London, UK.
Primary Care and Population Health, UCL, London, UK
BMJ Open. 2024 Jul 8;14(7):e082083. doi: 10.1136/bmjopen-2023-082083.
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 postdiagnostic dementia care. We aimed to increase the adoption of personalised care planning for people with dementia, exploring implementation facilitators and barriers.
Mixed-method feasibility and implementation study.
Seven general practices from four primary care networks (PCNs) in the Northeast and Southeast of England.
A medical records audit collected data on 179 community-dwelling people with dementia preintervention, 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.
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.
Adoption of personalised care planning was assessed through a preintervention and postintervention audit of medical records. Implementation barriers and facilitators were explored through semistructured qualitative interviews and non-participant observation, analysed using codebook thematic analysis informed by Normalisation Process Theory.
The proportion of personalised care plans increased from 37.4% (95% CI 30.3% to 44.5%) preintervention 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.
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.
ISRCTN11677384.
为痴呆患者提供个性化护理计划是国家的重点。研究表明，护理计划和审查的质量和一致性存在不足。PriDem 护理模式旨在提供可行且可接受的基于初级保健的诊断后痴呆护理。我们旨在增加痴呆患者个性化护理计划的采用，探索实施的促进因素和障碍。
混合方法可行性和实施研究。
英格兰东北部和东南部四个初级保健网络（PCN）的七家全科诊所。
一项病历审计在干预前收集了 179 名居住在社区的痴呆症患者的数据，在干预年期间收集了 215 名患者的数据。定性研究招募了 26 名卫生和社会保健专业人员、14 名痴呆症患者和 16 名与参与实践相关的照顾者。
临床痴呆症负责人（CDL）在参与的 PCN 中实施了为期 12 个月的系统级干预措施，以开发护理系统、增强员工能力和能力，并为痴呆症患者及其照顾者提供量身定制的护理和支持。
通过病历的预干预和后干预审计评估个性化护理计划的采用。通过半结构化定性访谈和非参与观察探索实施障碍和促进因素，并使用基于常规过程理论的代码本主题分析进行分析。
个性化护理计划的比例从干预前的 37.4%（95%CI 30.3%至 44.5%）增加到干预年的 64.7%（95%CI 58.3%至 71.0%）。定性研究结果表明，PriDem 干预措施的灵活性使员工能够通过利用更广泛的多学科团队的技能克服背景障碍，为患者提供越来越全面的护理。
通过团队方法可以实现有意义的个性化护理计划。尽管需要改进护理计划指南，但决策者应考虑由 CDL 领导的方法的好处。
ISRCTN85124121。
