Date Published: June 27, 2018
Publisher: Public Library of Science
Author(s): Anke Richters, Minke S. Nieuwboer, Marcel G. M. Olde Rikkert, Rene J. F. Melis, Marieke Perry, Marjolein A. van der Marck, Perla Werner.
This study aimed to provide insight into the merits of DementiaNet, a network-based primary care innovation for community-dwelling dementia patients.
Longitudinal mixed methods multiple case study including 13 networks of primary care professionals as cases. Data collection comprised continuously-kept logs; yearly network maturity score (range 0–24), yearly quality of care assessment (quality indicators, 0–100), and in-depth interviews.
Networks consisted of median nine professionals (range 5–22) covering medical, care and welfare disciplines. Their follow-up was 1–2 years. Average yearly increase was 2.03 (95%-CI:1.20–2.96) on network maturity and 8.45 (95%-CI:2.80–14.69) on quality indicator score. High primary care practice involvement and strong leadership proved essential in the transition towards more mature networks with better quality of care.
Progress towards more mature networks favored quality of care improvements. DementiaNet appeared to be effective to realize transition towards network-based care, enhance multidisciplinary collaboration, and improve quality of dementia care.
Chronic conditions like dementia pose a great challenge to health care systems. Primary care for community-dwelling dementia patients is multifaceted, especially in later stages in which the disease affects many aspects of the lives of patients and their informal caregivers. Medical issues fall under responsibility of the primary care physician (PP), but many patients also require other forms of care and support such as home care, nursing care, and temporary involvement of allied health professionals. Subsequently, patients often require case management to ensure continuity and availability of services, and primary care professionals are increasingly urged to work in a multidisciplinary manner.
Seventeen networks were successfully established of which 13 accomplished one or more active years in the DementiaNet program. Overall, this multiple case study showed an increase in both network maturity and quality of care and a positive association was indicated between these measures. Multidisciplinary collaboration, communication, and coordination of care improved according to healthcare professionals in the networks, and DementiaNet enabled them to beneficially impact care. Importantly, prerequisites for successful transition towards more mature and integrated networks were identified.