Implementing the National Dementia Strategy in England: Evaluating innovative practices using a case study methodology

Abstract

With dementia ever-increasing in prevalence and cost on society, and with recent reports emphasizing the need for improved and standardized diagnosis and care for patients with dementia, the National Dementia Strategy (NDS) has been published by the English Department of Health. The NDS encourages the identification of successful innovations to implement on a wider scale. This paper uses case studies to describe some examples of innovative practice in the diagnosis and management of patients with dementia in primary care. It goes on to discuss methodological problems in the evaluation and comparison of innovations in practice, focusing on the potential to compare complex with simple interventions, and recognizing the role that commissioners play in making decisions about the choice and implementation of innovation.

Keywords

dementia primary care National Dementia Strategy innovations

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References

Borson

Scanlan

Brush

Vitaliano

Dokmak

. (2000). The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. International Journal of Geriatric Psychiatry, 15(11), 1021–1027.

Bourdenave

. (1976). Communication of agricultural innovations in Latin America: The need for new models. Communication Research, 3(2), 135–154.

Bowling

. (2002). Research methods in health: Investigating health and health services, 2nd ed. Berkshire: Open University Press.

Brooke

Bullock

. (1999). Validation of the 6-item cognitive impairment test with a view to primary care usage. International Journal of Geriatric Psychiatry, 14, 936–940.

Brooke, P., Naidoo, M., & Rice, D. (2005). Final Report. Retrieved from http://www.falklandsurgery.co.uk/memory/.

Care Services Improvement Partnership (2007). NIMHE positive practice award: Older people andmental health. Retrieved from http://www.cat.csip.org.uk/index.cfm?pid=78&catalogueContentID=1068.

De Lepeliere

Wind

Iliffe

Moniz-Cook

Wilcock

Gonzalez

Derksen

Gianelli

Vernooij-Dassen

. the Interdem Group. (2008). The primary care diagnosis of dementia in Europe: An analysis using multi-disciplinary, multi-national expert groups. Aging & Mental Health, 12(5), 568–576.

Department of Health (2007a). Putting people first: A shared vision and commitment to the transformation of adult social care. Retrieved from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081118.

Department of Health (2007b). World Class Commissioning: Adding life to years and years to life.Retrieved from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080956.

10.

Department of Health (2008). The National End of Life Strategy. Retrieved from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086277.

11.

Department of Health (2009a). Living well with dementia: A National Dementia Strategy. Retrieved from http://www.dh.gov.uk/en/SocialCare/Deliveringadultsocialcare/Olderpeople/NationalDementiaStrategy/DH_083358.

12.

Department of Health (2009b). Living well with dementia: A National Dementia Strategy Annex 1, World Class Commissioning Guidance for Dementia. Retrieved from http://www.dh.gov.uk/en/SocialCare/Deliveringadultsocialcare/Olderpeople/NationalDementiaStrategy/DH_083358.

13.

Downs

Iliffe

Turner

Bryans

Wilcock

Keady

. (2002). How can we improve GP’s response to dementia. Journal of Dementia Care, 10, 18–19.

14.

Downs

Turner

Bryans

Wilcock

Keady

Levin

O’Carroll

Howie

Iliffe

. (2006). Effectiveness of educational interventions in improving detection and managementof dementia in primary care: Cluster randomised controlled study. BMJ, 332, 692–696.

15.

Folstein

McHugh

. (1975). ‘Mini-Mental State’. A practical method for grading the cognitive state of patients for clinicians. J Psychiatr Res, 12(3), 189–198.

16.

Greenhalgh

Robert

Macfarlane

Bate

Kyriiakidou

. (2004). Diffusion of innovations in service organisations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581–629.

17.

Ham

. (2006). Reforms to NHS commissioning in England. BMJ, 333, 211–212.

18.

Higgins

. (2007). Health policy: A new look at NHS Commissioning. BMJ, 334, 22–24.

19.

Iliffe

Wilcock

Austin

Walters

Rait

Turner

Bryans

Downs

. (2002). Dementia diagnosis and management in primary care: Developing and testing educational models. Dementia, 1(1), 11–23.

20.

May

Finch

Mair

Ballini

Dowrick

Eccles

Gask

MacFarlane

Murray

Rapley

Rogers

Treweek

Wallace

Anderson

Burns

Heaven

. (2007). Understanding the implementation of complex interventions in health care: the normalization process model. BMC Health Services Research, 7, 148–148. Retrieved from www.biomedcentral.com/1472-6963/7/148.

21.

Mays

Pope

. (1995). Rigour in qualitative research. BMJ, 311, 109–112.

22.

Mays

Pope

. (2000). Assessing quality in qualitative research. BMJ, 320, 50–52.

23.

Moras-Gallart

Davies

. (2006). Toward a theory-led evaluation: The experience of EuropeanScience, Technology and Innovation policies. American Journal of Evaluation, 27(1), 64–82.

24.

National Audit Office (2007). Improving services and support for people with dementia, Part Two, Case Study 3. Retrieved fromhttp://www.nao.org.uk/publications/0607/support_for_people_with_dement.aspx.

25.

National Institute for Clinical Excellence and Social Care Institute of Excellence (2006). Dementia: Supporting people with dementia and their carers in health and social care. Retrieved from http://www.nice.org.uk/nicemedia/pdf/CG042NICEGuideline.pdf.

26.

National Institute for Clinical Excellence (2007). Alzheimer’s Disease – donepezil, galantamine, rivastigmine (review), and memantine. Retrieved from http://www.nice.org.uk/TA111.

27.

Smith, J., Mays, N., Dixon, J., Goodwin, N., Lewis, R., McClelland, S., McLeod, H., & Wyke, S. (2004). A review of the effectiveness of primary care-led commissioning, and its place in the NHS, The Health Foundation, October. Retrieved from http://www.health.org.uk/publications/review-of-the-effectiveness-of-primary-care-led-commissioning-and-its-place-in-the-nhs.

28.

Strandberg-Larsen

Krasnik

. (2009). Measurement of integrated healthcare delivery: a systematic review of methods and future research directions. International Journal of Integrated Care. Vol. 9, 4 February 2009. Retrieved from http://www.ijic.org.

29.

Wade, E., Smith, J., Peck, E., & Freeman, T. (2006). Commissioning in the reformed NHS: Policy into practice. Birmingham: University of Birmingham Health Services Management Centre.

30.

Wakerman, J., Humphreys, J., Wells, R., Kuipers, P., Entwistle, P., & Jones., J. (2006). A systematic review of primary health care delivery models in rural and remote Australia 1993–2006. Canberra: Australian Primary Health Care Research Institute. Retrieved from http://www.anu.edu.au/aphcri/Domain/RuralRemote/Final_25_Wakerman.pdf.

31.

Wakerman

. (2009). Innovative rural and remote primary health care models: What do we know and what are the research priorities? Australian Journal of Rural Health, 17, 21–26.

32.

Weatherill

. (2007). Primary health care transition fund, laying the groundwork for cultural change: The legacy of the primary health care transition fund. Ottawa: Health Canada.

33.

Wikipedia (2008). http://en.wikipedia.org/wiki/Lean_manufacturing.

34.

Yin

R. K.

. (1999). Enhancing the quality of case studies in health service research. Health Services Research, 34(5 pt 2), 1209–1224.

35.

Zahra

George

. (2002). Absorptive Capacity: A review, reconceptualization, and extension. Academy of Management Review, 27(2), 185–203.