"Living well in a dementia-friendly society". St. Julian's, Malta, INTERDEM: Improving and promoting psychosocial care for persons with dementia

Transcription

1 "Living well in a dementia-friendly society". St. Julian's, Malta, 2013 INTERDEM: Improving and promoting psychosocial care for persons with dementia

2 Psychosocial approaches and memory clinics: from knowledge to practice. A comparison between Italy and UK Chattat Rabih, Moniz-Cook Esme, Fabbo Andrea, Carafelli Antonella, Doncaster Emily, Orrell Martin, Watts Sue rabih.chattat@unibo.it

3 Memory clinics Center of expertise for: - Initial diagnosis of memory disorders - Planning management - Early interventions - Follow-up - Therapeutic setting - Quality Indicators for memory clinics

4 Psychosocial Interventions Growing number of P.I. with established effectivness and cost effectiveness (Orrell, 2012). Availability along the course of the disease Guidelines of P.I. in european countries (Vasse et al., 2012) Quality indicators for P.I. in dementia (Vasse et al., 2012)

5 Background Development of evidence based standards for memory clinics in UK psychosocial interventions in Integration into standards used for accreditation of UK memory clinics. (Doncaster et al., 2011)

6 Memory clinics in Italy (Emilia-Romagna Region) Regional dementia plan ( 2000 under revision) Center for cognitive disorders (CDC): diagnosis, pharmacological treatment, psychosocial interventions for person with dementia, for family caregivers and for formal carers, follow-up, support for other services Comunity or hospital based, multidisciplinary team

7 Survey Based on evidence based psychosocial interventions standards a questionnaire had been developped: Diagnostic and care process; information provision Psychosocial interventions for PwD: cognition, behavior, emotion, functional-occupational aspects Psychosocial interventions for family caregivers

8 Survey Partecipants were asked to indicate : 1- for each intervention, if it is provided by the memory clinic team, if they refer to other organization/services or it is not currently available 2- the typical dosage for each intervention (number of session) 3- for assessment, diagnosis, driving issues, pre-post diagnostic issues (availability and number of contact session)

9 Survey For each question partecipant are also asked (free text box) to describe the process and their experience about the service - Comment about the process. - Detail about interventions they provide. - Detail about other interventions provided and not mentioned.

10 Procedure Survey questionnaire was first developped in UK Translated into italian An is sent to all partecipant with a link to access online the survey One month is given for partecipants to complete the survey A reminder is sent nearer to the deadline

11 Partecipants Emilia Romagna (Italy): 53 CDC receive the survey; 29 reply (55% response rate) UK: 49 memory clinics (MSNAP) receive the survey; 20 MC reply (40% response rate)

12 Processes about assessment and diagnosis 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% not provided as routine more 1 contact session 1 contact session

13 Interventions for carers 140% 120% 100% 80% 60% 40% not currently available refer to other provided by MC 20% 0%

14 Information provision 140% 120% 100% 80% 60% 40% not currently available refer to other provided by MC 20% 0% written written info. PI. Uk info. PI. IT memory cafè UK memory cafè IT written info other Uk written info other It written info aspects dem care UK written info aspects dem. care It

15 Interventions for cognitive aspects 120% 100% 80% 60% 40% not currently available refer to other provided by MC 20% 0%

16 Interventions for emotional aspects 120% 100% 80% 60% 40% not currently available refer to other provided by MC 20% 0% Group Th. Uk Group. Th. IT CBT UK CBT IT Behav Th.. Uk Behav. Th. It Emotion Multi Emotion Multi IT

17 Intervention for occupational and functional aspects 140% 120% 100% 80% 60% 40% not currently available refer to other provided by MC 20% 0% Pers. Tail. Pers. Tail. OTUk OT. IT Soc. Behav. Manag. UK Soc. Behav. Mang. IT Advice Assit. Tech.UK Advice Assit. Tech.IT Supp- Self. Care UK Supp. Self-care IT

18 120% Interventions to promote Continuity of care 100% 80% 60% 40% not currently available refer to other provided by MC 20% 0% Pers. Care Plan.Uk Pers.care plan. IT Dem. Adv. Navig. UK Dem. Adv. Navig. IT care coord.uk Care coord. IT case manag. UK case manag. IT

19 Dosage UK: the majority of interventions were provided over 6 16 sessions/contacts. The exceptions to this were the interventions provided in less than 6 contacts/sessions (life story work, tele-care advice, family interventions and carer counselling) and interventions provided in 17 or more contacts/sessions (contact with dementia advisors and care co-ordinators). IT: all of the interventions were provided in 6 sessions or less, apart from personally tailored occupational therapy, which was provided in 6-16 sessions

20 Qualitative analysis: Problem focused attitudes Symptoms, problems assessment rather than need assessment, ( ex: driving issues); using validated instruments Sharing decision process: person with dementia is less involved; the caregiver is informed about. The support both in pre-diagnostic and post-diagnostic processes is seen in terms of informed consent (comunication skills) or in term in prescription (of interventions or links to other organizations).

21 Services/pratitionner based interventions Not all interventions are available: referring based on availability of interventions rather than on needs The continuity of care more based on demand rather than on a pro-active process. Coordination and integration of care with other services/organization. (referring rather than sharing).

22 Caution!! It is the opinion of the practitionner and don t reflect the what is happening. We refer to two area with high standard quality level in services provision. The first survey on psychosocial intervention and memory clinics The information exchange between MC and other organization (referring rather than sharing.

23 Comments Memory clinics are more than an assessment and diagnosis center: information provision, interventions for person with dementia and caregivers, MID term care setting A wide range of psychosocial interventions are available: directly or by referring to other organizations High variability between setting. Limited interventions for person with dementia Process and interventions are more based on system resource rather than on persons needs

24 Promoting Interventions based on need assessment Tailored interventions; multicomponent interventions Integration of interventions, proactive approach and continuity of care Integration between memory clinic and other services or organizations Utility of standards for process and interventions Comunication skills

25 Thanks for your attention