Search

OBJECTIVES: To construct a set of quality indicators (QIs) for dementia diagnosis and management in a primary care setting. DESIGN: RAND modified Delphi method, including a postal survey, a stakeholders consensus meeting, a scientific expert consensus meeting, and a demonstration project. SETTING: Primary care. PARTICIPANTS: General practitioners (GPs), primary care nurses (PCNs), and informal caregivers (ICs) in postal survey and stakeholders consensus meeting. Eight national dementia experts in scientific consensus meeting. Thirteen GPs in the demonstration project. MEASUREMENTS: Mean face validity and feasibility scores. Compliance rates using GPs' electronic medical record data. RESULTS: The initial set consisted of 31 QIs. Most indicators showed moderate or good face validity and feasibility scores. Consensus panels reduced the preliminary set used in the demonstration project to 24 QIs. The overall compliance to the QIs was 45.3%. Discriminative validity of the set was good; significant differences in adherence were found between GPs with high and low levels of patients aged 65 and older in their practice, with and without PCNs, and with positive and negative attitudes toward dementia (all P<.05). Based on the demonstration project, one QI was excluded. The final set consisted of 23 QIs; 15 QIs contained innovative quality criteria on collaboration between GPs and PCNs, referral criteria, and assessment of caregivers' needs. CONCLUSION: This new set of dementia QIs is feasible, reliable, and valid and can be used to improve primary dementia care. Because of the innovative quality criteria, the set is complementary to the existing dementia QIs. [ABSTRACT FROM AUTHOR]

Contemporary healthcare policies are designed to shape the conditions that can help delay the institutionalization of patients with dementia. This can be done by developing support programs that minimize healthcare risks for the patients with dementia and their informal caregivers. Many support programs have been developed, and some of them are effective, but there has been no systematic review with a meta-analysis of all types of nonpharmacological support programs with odds of institutionalization or time to institutionalization as an outcome measure. A systematic review with a meta-analysis was therefore conducted to estimate the overall effectiveness of nonpharmacological support programs for caregivers and patients with dementia that are intended to delay institutionalization. Thirteen support programs with a total of 9,043 patients were included in the meta-analyses. The estimated overall effectiveness suggests that these programs significantly decrease the odds of institutionalization (odds ratio (OR)=0.66, 95% confidence interval (CI)=0.43–0.99, P=.05) and significantly increase the time to institutionalization (standardized mean difference (SMD)=1.44, 95% CI=0.07–2.81, P=.04). A meta-analysis of the best-quality studies still showed a positive significant result for the odds of institutionalization (OR=0.60, 95% CI=0.43–0.85, P=.004), although the time to institutionalization was no longer significant (SMD=1.55, 95% CI=–0.35– 3.45, P=.11). The analysis of the intervention characteristics showed that actively involving caregivers in making choices about treatments distinguishes effective from ineffective support programs. Further investigation should be directed toward calculating the potential efficiency of these support programs by applying net-benefit or cost-effectiveness analysis. [ABSTRACT FROM AUTHOR]