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Delivering systems-level change to improve post-diagnostic dementia support: Qualitative findings from the PriDem
Emily Spencer1, Katie Flanagan2, Marie Poole3
1Research Department of Primary Care and Population Health, Institute of Epidemiology & Healthcare, Faculty of Population Health Sciences, University College London, London, United Kingdom.
Plos One
|March 28, 2025
Summary
Implementing a new dementia care model in primary care is feasible, showing positive effects for patients and carers. Motivated staff and understanding complex interventions are key to sustainable dementia care improvements.
Area of Science:
- Gerontology
- Health Services Research
- Primary Care Medicine
Background:
- 900,000 individuals in England and Wales live with dementia.
- Current post-diagnostic support models are unsustainable and unaffordable.
- The PriDem program introduced a novel primary care-based dementia care model facilitated by a Clinical Dementia Lead (CDL).
Purpose of the Study:
- To evaluate the barriers and facilitators encountered during the implementation of the PriDem intervention.
- To assess the feasibility and sustainability of a primary care-based dementia care model.
Main Methods:
- A qualitative process evaluation was conducted across 7 general practices in England.
- Data collection involved semi-structured interviews with 26 healthcare professionals, 14 people with dementia, and 16 carers.
- Analysis utilized abductive codebook thematic analysis, guided by Normalisation Process Theory (NPT).
Main Results:
- Six themes emerged, including challenges within primary care, the impact of individuals, balancing adaptability with fidelity, and reimagining care planning.
- NPT provided insights into contextual challenges, mechanisms for overcoming them, and the potential for sustainable changes.
- The intervention demonstrated positive effects on both individuals and healthcare systems, suggesting a path towards sustainability.
Conclusions:
- Meaningful improvements in dementia care within primary care are achievable despite existing pressures.
- Engaged staff and clear understanding of complex interventions are crucial for successful implementation and fidelity.
- A CDL-led approach offers significant benefits for people with dementia, carers, and healthcare systems, warranting consideration by commissioners.
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