Healthcare organisation and delivery for people with dementia and comorbidity: a qualitative study exploring the views of patients, carers and professionals
Authors
Bunn, F
Robinson, L
Poole, M
Rait, G
Schoeman, J
Norton, S
Goodman, C
Publication Date
2017-01-01Journal Title
BMJ Open
ISSN
2044-6055
Publisher
BMJ Publishing Group
Volume
7
Number
e013067
Language
English
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Bunn, F., Burn, A., Robinson, L., Poole, M., Rait, G., Brayne, C., Schoeman, J., et al. (2017). Healthcare organisation and delivery for people with dementia and comorbidity: a qualitative study exploring the views of patients, carers and professionals. BMJ Open, 7 (e013067)https://doi.org/10.1136/bmjopen-2016-013067
Abstract
$\textbf{OBJECTIVES}$: 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.
$\textbf{DESIGN}$: Qualitative study involving interviews and focus groups. Thematic content analysis was informed by theories of continuity of care and access to care.
$\textbf{SETTING}$: Primary and secondary care in the South and North East of England.
$\textbf{PARTICIPANTS}$: PLWD who had 1 of the following comorbidities-diabetes, stroke, vision impairment, their family carers and healthcare professionals (HCPs) in the 3 conditions.
$\textbf{RESULTS}$: 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.
$\textbf{CONCLUSIONS}$: 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.
Keywords
diabetes & endocrinology, qualitative research, comorbidity, vision impairment
Sponsorship
This article presents independent research commissioned by the National Institute for Health Research (NIHR) under HS&DR (grant reference number 11/1017/07).
Embargo Lift Date
2100-01-01
Identifiers
External DOI: https://doi.org/10.1136/bmjopen-2016-013067
This record's URL: https://www.repository.cam.ac.uk/handle/1810/262754
Rights
Attribution 4.0 International, Attribution 4.0 International, Attribution 4.0 International