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The Peri-Dementia Diagnostic Service (PoDDS): a study protocol for a nurse-enhanced primary care service.

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Peri-Dementia Diagnostic Support Service (PoDDS):

A quality improvement study

In current practice, following diagnosis in the Cognitive Dementia

and Memory Service (CDAMS) the person is directed to the General Practitioner to provide support and on-going management.

However, it is well acknowledged that post-diagnostic care for people with dementia and their families is poorly managed. (1) Reasons include:

• significant barriers to dementia care exist in General Practice (2)

• co-morbidities in people with dementia are often under- diagnosed and under-treated (3)

• people with dementia experience difficulties accessing appropriate information and services (4)

Inadequate dementia care following diagnosis potentiates the risk for inappropriate management, poor psychological adjustment and reduced coping capacity and ability to forward plan. (4)

Caroline Gibson

1

, Mark Yates

2

, Melinda Farnsworth

1

1 Ballarat Health Services

2 Ballarat Innovation & Research Collaboration for Health

This project is an Australian Primary Care Nurse Association Building Nurse Capacity – improving patient outcomes. Funded by the Australian Government Department of Health under the Nursing in Primary Health Care programme 2018-2022.

References

1. Kelly F, and Innes A. (2016) Facilitating independence: The Benefits of a post-diagnostic support project for people with dementia. Dementia. 15(2):162-180 2. Phillips, J., Pond, D., & Goode, S. (2011) Timely diagnosis of Dementia: Can we do better? A report for Alzheimer's Australia. Paper 24

3. Bunn F, Burn A, Goodman C, Robinson L, Rait G, Norton S, et al. Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem). Health Service Delivery Research.

2016;4(8).

4. Duane F, Goeman D, Beanland C and Koch S. (2015) The role of a clinical nurse consultant dementia specialist: A qualitative evaluation. Dementia. Vol. 14(4) 436–449

5. State of Victoria, Department of Human Services (2008). Health Independence Programs Guidelines. Victorian Government Department of Human Services, Melbourne, Victoria, Australia

Study purpose

The opportunity

The Hospital at Risk Program (HARP) aims to:

• reduce avoidable admissions and presentations to hospital

• manage people with chronic disease, aged and/ or complex needs to improve patient outcomes

• provide integrated seamless care within and across hospital and community sectors.

Both CDAMS and HARP are Health Independence Programs

(HIP). HIP guidelines state that a person is to receive the right care, in the right place, at the right time, unhampered by

program boundaries. (5)

Integrating care: PoDDS

A better client journey (adapted) (5)

Access and initial contact

Initial needs

identification Assessment

Care planning and

implementation

Monitoring and review

Transition and exit

CDAMS diagnostic process

HARP care coordination

Can CDAMS and HARP provide an integrated service to better support people going through the

diagnostic process facilitating improved health outcomes and community integration?

The Peri-Dementia Diagnostic Service (PoDDS) model of care will be developed within HARP. PoDDS involves an advanced practice community- based nurse providing person-centred care for people in the adjustment period prior to, during,

and after receiving the diagnosis of dementia.

Referral criteria

• CDAMS client

• Eligible for HARP

• Geographic or social isolation

• Poor links to primary health care providers

• Unsupported through the diagnostic process

Developing PoDDS and measuring outcomes

Development

• Plan-Do-Study-Act methodology Process measures

• Number of PoDDS patients handed over to General Practice with an operationalised care plan

• Sustainablity

Outcome measures

• Patient experience

• Health practitioner experience Tools

• Zarit Carer Burden

• Qualitative interviews

• Mapping patient journey

Introduction

Referensi

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