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Educational intervention used to improve health professionals’ knowledge about dementia in primary care

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8Dementia in Primary Care

ЕDUСАTIОNАL INTЕRVЕNTIОN USЕD TО IMРRОVЕ HЕАLTH РRОFЕSSIОNАLS’ KNОWLЕDGЕ АBОUT DЕMЕNTIА IN РRIMАRY САRЕ

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Еduсаtiоnаl Intеrvеntiоn usеd tо Imрrоvе Hеаlth Рrоfеssiоnаls’ Knоwlеdgе Аbоut Dеmеntiа in Рrimаry Саre

Introduction

An intervention involves the combination of strategies and elements structured and intended to result in behavioral changes and improve the health status of a target population or among people. Educational interventions are thus aimed at improving the outcome related to particular areas of concern in healthcare. According to Iliffe et al. (2012), educational interventions that are used to improve health professionals’ knowledge about dementia are interventions directed at improving the professionals’ knowledge on all aspects related to dementia in primary care. Wilcock et al. (2013) define primary care as the routine health care that is given by a health care professional or health care personnel. Primary health care is the principal contact and the first point in relation to continuing care given to a patient in the system of health care. Primary care health provider is also tasked with coordinating any specialist care a patient may require. In this way, it is important to evaluate the educational interventions that are available and used to improve these professionals’ knowledge about dementia in principal care. This paper presents a review literature on the interventions aimed at improving knowledge about dementia in primary care by health care professionals.

Dementia

Dementia includes a wide category of brain illnesses that result in gradual and long-term decrease in the brain’s ability and functions (Edwards et al., 2012). The disease affects the ability to think and recall and is severe enough to impact on an individual’s ability to function normally in their day-to-day living. Dementia symptoms and associated effects include language problems, emotional difficulties and decline in motivation. However, the disease has no effect on an individual’s conscience. It is important to note that dementia also has a great impact on a diagnosed patient’s caregivers.

The symptoms of the disease may vary in relation to the type of diagnosis and the stage at which the patient is in the illness. The most frequently affected areas include an individual’s memory, language, attention, visual-spatial and their ability to solve problems. The disease usually progresses slowly over time and by the time a patient begins to show signs, the process of degeneration in the brain has been ongoing for quite some time (Cherry et al., 2009). Most patients will have other behavioral and psychological problems, which include balance problems, speech difficulties, distorted memories, restlessness, perceptual problems, visual difficulties. All types of dementia will have an occurrence of behavioral and psychological problems that may manifest in the form of agitation, anxiety, depression, mood disorders, apathy, delusions, sleep problems, appetite problems, and irritability among others.

As Perry et al. (2008) observes, the first stages of the disease the symptoms and signs are subtle and not very evident and most of the time, they only become evident on recollection after the illness has progressed. The initial stage of dementia is known as mild cognitive impairment where the symptoms are beginning to become evident. However, they are not severe enough yet to impact on the patient’s daily functioning. This is followed by the early phases of the disease in which the patient begins showing symptoms that are noticeable to those around them. Symptoms at this stage may begin to have an effect on their daily lives and functioning. The middle stages of dementia follow where there is a general worsening of symptoms and impairment becomes more severe (Brody and Galvin, 2013). The late stages of dementia are when the illness renders the patient dependent on others for their daily functions and may need round the clock care and supervision for safety and basic needs attention such as personal hygiene and feeding among others.

Importance of improving Dementia care in primary care

Primary care health professional routinely provide care for dementia patients. However, these primary care professionals might lack adequate awareness and skills of the resources needed and available to give dementia patients ideal care. It is important to improve dementia care and associated knowledge among health care professionals due to the rising cases of dementia in the world today. In addition, Perry et al. (2008) notes that the specialized nature of the disease and the presentation of various associated symptoms make dementia an area of concern since the disease affects almost every aspect of a patient’s life. Primary health care professional need to be equipped with knowledge and resources that enable them to manage and provide the best care to patients showing up with various symptoms if the disease is to be effectively managed.

More than one person over the age of sixty-five has dementia. Studies conducted and predictive models point to a possible rise in dementia cases in the near future with estimates of up to a three times rise in cases of dementia. In the health care structure and establishments, primary health care providers are often responsible or the medical management of majority of the cases (Wilcock et al., 2013). However, due to the generally compound and complex psychological, behavioral. social, and medical needs of patients presenting with dementia, the regular primary care professional has trouble providing model care. In improving dementia care in primary care, it is important to note that the health care system also has some barriers that affect the management and care of dementia in primary care. Such barriers include inadequate time, lack of adequate support staff, low compensation, and difficulty in accessing specialists and insufficient connections with social service agencies in the community among other barriers (Cherry et al., 2009). Evidence in studies conducted show that primary care health professionals often lack the requisite knowledge and skills for appropriate diagnosis, screening, and treatment of the illness. These factors contribute to delayed, disregarded, or unnoticed cases of dementia and diagnoses thereby contributing to missed treatment opportunities, care planning and associate support for caregivers.

Among the most unnoticed areas in the primary care of the illness according to Hughes et al. (2008) is the lack of dynamic partnership among health care providers and the numerous community resources accessible to caregivers and families. A lot of primary health care professionals report insufficient knowledge of the available resources in addition to discomfort with counseling and the education of families including low rates of referrals to social services. In this respect, existing community resources are often insufficiently used in as much evidence shows that combining primary care with community resources can help decrease the rates of patient admission and improve the overall management of dementia. It also helps by improving the satisfaction of caregivers and their depression in addition to improving the quality of care as observed by Iliffe et al. (2012).

Literature Review

Various studies have been conducted on educational interventions used to improve health professionals’ knowledge about dementia in primary care. The study by Hughes et al. (2008) looks at health staffs who work dementia patients. The study is an examination of the degree of knowledge and confidence that primary care professionals dealing with dementia patients have in addition to identification of factors contributing to the confidence of primary health care providers. The results of the study reveals that primary health care professional have reasonable knowledge in relation to dementia. However, the confidence of these professionals is low when dealing with patients presenting with dementia. The results in the study’s content reveal that training can have a positive impact on health care professional confidence in relation to dementia care. The design of the study involved regional study of homes in England that were selected in a random manner and in metropolitan districts. Questionnaires were sent to the target population of the study to evaluate the knowledge of primary health care providers of dementia patients. The evaluation and analysis of results indicated sufficient knowledge among primary health care providers but limited confidence in dealing with dementia cases and the provision of care to patients presenting with dementia symptoms and signs.

According to Perry et al. (2008), dementia cases in primary care are currently under-diagnosed. However, the study notes that educational interventions aimed at improving the diagnosis of the illness and management in primary care were successful which means that the results of these interventions showed an increase in diagnosis in primary care and in primary health care professionals. Brody and Galvin (2013) in their study reviewed inter-professional education and dissemination interventions aimed at the recognition and management of the illness. The study was based on a methodical review of literature based on educational interventions for health care professionals in regard to dementia in a span of 22 years from 1990 to 2012. The study was confined to articles from peer reviewed journals. The results indicated that improved knowledge of primary care providers had a significant impact on disease management, care and quality of care.

Such educational interventions for primary health care providers as noted by Illife et al. (2010) observed through randomized trials the vital impact of knowledge of healthcare professionals especially when dealing with the care and management of dementia. Edwards et al. (2012) evaluated the importance of health care professional knowledge and the approach taken in primary health care provision in dementia. The study cited diminished knowledge and reluctance associated with dementia diagnosis and the fact that improved knowledge among health care providers improved the quality of care for patients. The study by Cherry et al. (2009) evaluated the position of educating primary care physicians in the management of dementia disease through training guidelines to institute quality standards. By looking at three studies centered on dementia care, the study notes the significant role of training in addition to management and supplementary interventions for an improved primary care in health care providers. Various studies also center on the development of educational interventions on diagnosis of the illness and the management of primary care. Illife et al. (2012) employed the use of a multidisciplinary team as an approach to creating an educational needs assessment tool that would be used to write educational prescriptions by primary health care professional in the diagnosis of dementia.

According to the study by Edwards et al. (2013), development and assessment of primary care educational interventions is vital in stimulating patient-centered response by primary health care personnel in dementia cases and the illness management. The study’s method employed a pilot test of a prototype educational intervention. The results indicated an improvement in primary care of dementia for health care providers who had undergone training compared to those who had not. Wilcock et al. (2013) also used a tailored educational intervention and controlled trial that was tested in randomized and controlled design. The outcome indicated an increase in primary care of dementia patients by primary health care professionals who had undergone training. Charter and Hughes (2012) evaluated literature based on educational interventions and the limitations as associated with these interventions in primary health care and professionals. The study employed the use of a descriptive qualitative approach with data generated through focus groups. The indication in the results called for an improvement in primary care and knowledge for primary care providers of patients with dementia.

Summary of Articles

Hughes, J., Bagley, H., Reilly, S., Burns, A. and Challis, D., 2008. Care staff working with people with dementia Training, knowledge and confidence. Dementia, 7(2), pp.227-238.

Authors and published year: Hughes, J., Bagley, H., Reilly, S., Burns, A. and Challis, D., 2008

Aim: Examining confidence and knowledge levels of healthcare professionals in caring for dementia patients and factors contributing to confidence

Participants: 500 homes in North West England and 30 homes in ten metropolitan districts close to the research center all randomly selected

Design and methods: The research developed postal questionnaires and sent to homes of participants. It also conducted telephone interviews and staff questionnaires

Findings: The findings show evidence that professional in care homes appeared to have gotten limited training especially in relation to mental health requirements of patients presenting with dementia

Limitations: The data was taken from convenience sample of available staff on the day of data collection as such; the possibility of all groups not represented is one limitation of the study

Data collected through self-administered questionnaire is prone to error

Instruments used: Questionnaires and telephone interviews.

Perry, M., Drašković, I., van Achterberg, T., Borm, G.F., Van Eijken, M.I.J., Lucassen, P.L., Vernooij-Dassen, M.J.F.J. and Rikkert, M.O., 2008. Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial. BMC health services research, 8(1), p.1.

Authors and published year:Perry, M., Drašković, I., van Achterberg, T., Borm, G.F., Van Eijken, M.I.J., Lucassen, P.L., Vernooij-Dassen, M.J.F.J. and Rikkert, M.O., 2008

Aim: Finding out if the collaboration between General Practitioners and nurses in dementia care improved cognitive assessment and diagnoses in addition to attitude and knowledge of health care professionals

Participants: 100 recruited GPs and nurses in Netherlands

Design and methods: The study employed the use of DTP educational intervention and two workshops in addition to access to forum on the internet, coaching program, and electronic Clinical Decision Support System.

Findings: The development of the multifaceted dementia training program was based on previous success rate of educational interventions and is to be tested for success

Limitations: Selection bias and contamination were noted as possible dangers to dependability of the trial’s future results

Instruments used: Workshops, coaching programs, internet, and Clinical Decision Support System.

Brody, A.A. and Galvin, J.E., 2013. A review of interprofessional dissemination and education interventions for recognizing and managing dementia. Gerontology & geriatrics education, 34(3), pp.225-256.

Authors and published year: Brody, A.A. and Galvin, J.E., 2013

Aim: The study’s goal was based on emphasizing dissemination of existing evidence-based care and ascertaining inter-professional programs for better patient-centered care

Participants: Review of literature from 136 peer reviewed articles

Design and methods: Systematic literature review following Cochrane Handbook for Systematic Reviews of Interventions

Findings: The study’s results showed a need to increase implementation studies in dementia care especially with inter-professional intervention

Limitations: Studies not meeting inclusion and exclusion criteria from review of abstracts

The review’s inclusion of wide array of studies with differing methodologies made it impossible to directly compare results

Instruments used: Peer reviewed articles on dementia care

Iliffe, S., Wilcock, J., Griffin, M., Jain, P., Thuné-Boyle, I., Koch, T. and Lefford, F., 2010. Evidence-based interventions in dementia: A pragmatic cluster-randomised trial of an educational intervention to promote earlier recognition and response to dementia in primary care (EVIDEM-ED). Trials,11(1), p.1.

Authors and published year:Iliffe, S., Wilcock, J., Griffin, M., Jain, P., Thuné-Boyle, I., Koch, T. and Lefford, F., 2010

Aim: Testing customized educational intervention advanced for general practice in addition to the promotion of early diagnosis of the illness and compliance with management guidelines

Participants: Primary care providers, caregivers and dementia patients

Design and methods: The tailored educational intervention merges electronic support material with practice based workshops. The efficacy to be tested in randomized controlled trial

Findings: The programs deliverables include educational intervention for nursing and general practice.

Limitations: The National Dementia Strategy may influence results

Instruments used: Electronic resources.

Edwards, R., Voss, S. and Iliffe, S., 2012. Education about dementia in primary care: Is person-centeredness the key? Dementia, p.1471301212451381.

Authors and published year:Edwards, R., Voss, S. and Iliffe, S., 2012

Aim: The study explored patient-centered understanding of dementia and the part of primary care in the needs of the illness and experiences

Participants: Focus groups containing service users, professionals, and caregivers

Design and methods: The study recruited a series of focus groups and used open ended discussions among group members

Findings: From analysis of the data, the study found out that barriers to effective control of dementia and recognition exist in primary care and need to be addressed

Limitations: Information from focus group discussions can be unreliable

Instruments used: Focus groups

Cherry, D.L., Hahn, C. and Vickrey, B.G., 2009. Educating primary care physicians in the management of Alzheimer’s disease: using practice guidelines to set quality benchmarks. International psychogeriatrics, 21(S1), pp. S44-S52.

Authors and published year: Cherry, D.L., Hahn, C. and Vickrey, B.G., 2009

Aim: Presentation of a training approach for health care providers in identifying, diagnosing and managing dementia as a constituent of diseases associated with Alzheimer’s

Participants: Review of three studies

Design and methods: The study reviewed three studies based on dementia management and care and the training of primary care providers

Findings: The study found that training was a major part of strategies aimed at improving care

Limitations: Limited number of studies

Instruments used: Scholarly articles on dementia management and care

Iliffe, S., Koch, T., Jain, P., Lefford, F., Wong, G., Warner, A. and Wilcock, J., 2012. Developing an educational intervention on dementia diagnosis and management in primary care for the EVIDEM-ED trial. Trials, 13(1), p.1.

Authors and published year: Iliffe, S., Koch, T., Jain, P., Lefford, F., Wong, G., Warner, A. and Wilcock, J., 2012

Aim: The paper aimed to report the development of a tool for Educational Needs Assessment to direct structured interventions intended to improve timely diagnosis and management of the illness in primary care

Participants: Expert group

Design and methods: The study method employed the use of a multidisciplinary team in developing a strategy to construct an educational needs assessment tool.

Findings: The use of educational prescriptions proved useful in ensuring professional prioritized diagnosis and assessment in dementia patients

Limitations: Oversimplification of the proposed model by experts

Instruments used: Pilot practices

Edwards, R., Voss, S.E. and Iliffe, S., 2015. The development and evaluation of an educational intervention for primary care promoting person-centered responses to dementia. Dementia, 14(4), pp.468-482.

Authors and published year:Edwards, R., Voss, S.E. and Iliffe, S., 2015

Aim: To develop and assess educational intervention for primary care in addition to the promotion of patient-centered approach to patients with dementia

Participants: Volunteer practices

Design and methods: The study pilot tested a prototype educational intervention and polished it and finally evaluated it in four volunteer practices

Findings: The study determined that after training, there was significant improvement in comprehending person-centered care for patients in addition to prompt diagnosis, awareness and attitude change among primary care providers

Limitations: The materials did not address certain factors of primary care for dementia

Instruments used: Questionnaires

Wilcock, J., Iliffe, S., Griffin, M., Jain, P., Thuné-Boyle, I., Lefford, F. and Rapp, D., 2013. Tailored educational intervention for primary care to improve the management of dementia: the EVIDEM-ED cluster randomized controlled trial. Trials, 14(1), p.1.

Authors and published year:Wilcock, J., Iliffe, S., Griffin, M., Jain, P., Thuné-Boyle, I., Lefford, F. and Rapp, D., 2013

Aim: To assess and weigh the outcome of workplace structured educational intervention for healthcare practice on dementia management

Participants: Group practices within North Thames

Design and methods: Testing of tailored educational intervention in randomized control trial

Findings: The study found that customized educational intervention directed at professionals does not advance documentation of control or identification for people with dementia

Limitations: The study may need to include coordinated case management for better results

Instruments used: Discussions and questionnaires

Chater, K. and Hughes, N., 2012. Strategies to deliver dementia training and education in the acute hospital setting. Journal of Research in Nursing, p.1744987112446242.

Authors and published year:Chater, K. and Hughes, N., 2012

Aim: The study aimed to develop new ideas on training approaches for health care professionals who care for dementia patients

Participants: Focus groups of healthcare assistants and staff nurses

Design and methods: The study used descriptive qualitative approach

Findings: Four categories emerged from the analysis and they included learning about the illness, patient, learning from specialists and lastly colleagues

Limitations: Narrow scope of focus groups

Instruments used: Discussions

References

Brody, A.A. and Galvin, J.E., 2013. A review of interprofessional dissemination and education interventions for recognizing and managing dementia. Gerontology & geriatrics education34(3), pp.225-256.

Chater, K. and Hughes, N., 2012. Strategies to deliver dementia training and education in the acute hospital setting. Journal of Research in Nursing, p.1744987112446242.

Cherry, D.L., Hahn, C. and Vickrey, B.G., 2009. Educating primary care physicians in the management of Alzheimer’s disease: using practice guidelines to set quality benchmarks. International psychogeriatrics21(S1), pp. S44-S52.

Edwards, R., Voss, S. and Iliffe, S., 2012. Education about dementia in primary care: Is person-centeredness the key? Dementia, p.1471301212451381.

Edwards, R., Voss, S.E. and Iliffe, S., 2015. The development and evaluation of an educational intervention for primary care promoting person-centered responses to dementia. Dementia14(4), pp.468-482.

Hughes, J., Bagley, H., Reilly, S., Burns, A. and Challis, D., 2008. Care staff working with people with dementia Training, knowledge and confidence. Dementia7(2), pp.227-238.

Iliffe, S., Koch, T., Jain, P., Lefford, F., Wong, G., Warner, A. and Wilcock, J., 2012. Developing an educational intervention on dementia diagnosis and management in primary care for the EVIDEM-ED trial. Trials13(1), p.1.

Iliffe, S., Wilcock, J., Griffin, M., Jain, P., Thuné-Boyle, I., Koch, T. and Lefford, F., 2010. Evidence-based interventions in dementia: A pragmatic cluster-randomised trial of an educational intervention to promote earlier recognition and response to dementia in primary care (EVIDEM-ED). Trials,11(1), p.1.

Perry, M., Drašković, I., van Achterberg, T., Borm, G.F., Van Eijken, M.I.J., Lucassen, P.L., Vernooij-Dassen, M.J.F.J. and Rikkert, M.O., 2008. Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial. BMC health services research8(1), p.1.

Wilcock, J., Iliffe, S., Griffin, M., Jain, P., Thuné-Boyle, I., Lefford, F. and Rapp, D., 2013. Tailored educational intervention for primary care to improve the management of dementia: the EVIDEM-ED cluster randomized controlled trial. Trials14(1), p.1.