Refined conceptual model for implementing dementia risk reduction: incorporating perspectives from Australian general practice
Kali Godbee
A D , Jane Gunn A , Nicola T. Lautenschlager B C and Victoria J. Palmer A
A Department of General Practice, Melbourne Medical School, The University of Melbourne, Vic. 3010, Australia.
B Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Vic. 3010, Australia.
C Aged Persons Mental Health Program, Royal Melbourne Hospital, Royal Park Campus, Building 5, Level 1, 34–54 Poplar Road, Parkville, Vic. 3052, Australia.
D Corresponding author. Email: kgodbee@unimelb.edu.au
Australian Journal of Primary Health 26(3) 247-255 https://doi.org/10.1071/PY19249
Submitted: 19 December 2019 Accepted: 11 February 2020 Published: 27 May 2020
Abstract
Dementia is now a global health priority. With no known cure, the best way to reduce the number of people who will be living with dementia is by promoting dementia risk reduction (DRR). However, despite evidence-based guidelines, DRR is not yet routinely promoted in Australian general practice. Previously, we proposed a preliminary conceptual model for implementing DRR in primary care based on our scoping review of practitioners’ views. The present study aimed to refine this model for the Australian context by incorporating the current perspectives of Australian general practitioners (GPs) and general practice nurses (GPNs) about DRR. Interviews with 17 GPs and GPNs were analysed using the framework method, underpinned by the Consolidated Framework for Implementation Research (CFIR). We identified 12 barriers to promoting DRR in Australian general practice, along with five facilitators. Using the CFIR–Expert Recommendations for Implementing Change (ERIC) Matching Tool to select prioritised implementation strategies from the ERIC project, the findings were incorporated into a refined conceptual model. The refined model points to an implementation intervention that uses educational materials and meetings to reach consensus with GPs and GPNs on the importance of promoting DRR and an appropriate approach. Champion GPs and GPNs should be prepared to drive the agreed implementation forward, and general practices should share successes and lessons learned. This model is a crucial step in bridging the gap between DRR guidelines and routine practice.
Additional keywords: health promotion, primary health care, primary prevention, quality of health care.
References
Australian Bureau of Statistics (2016a) Australian Statistical Geography Standard (ASGS): Volume 5 – remoteness structure, July 2016 (Catalogue no. 1270.0.55.005). (ABS: Canberra, ACT, Australia) Available at https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1270.0.55.005July%202016 [Verified 18 December 2019]Australian Bureau of Statistics (ABS) (2016b) Census of population and housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2016 (Catalogue no. 2033.0.55.001). (ABS: Canberra, ACT, Australia) Available at https://www.abs.gov.au/ausstats/abs@.nsf/mf/2033.0.55.001 [Verified 18 December 2019]
Birken SA, Powell BJ, Shea CM, Haines ER, Alexis Kirk M, Leeman J, Rohweder C, Damschroder L, Presseau J (2017) Criteria for selecting implementation science theories and frameworks: results from an international survey. Implementation Science 12, 124
| Criteria for selecting implementation science theories and frameworks: results from an international survey.Crossref | GoogleScholarGoogle Scholar | 29084566PubMed |
CFIR Research Team (2018a) Codebook Template. Available at https://cfirguide.org/wp-content/uploads/2019/08/cfircodebooktemplate10-27-2014.docx [Verified 19 May 2020]
CFIR Research Team (2018b) Complexity. Available at https://cfirguide.org/constructs/complexity [Verified 19 May 2020]
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC (2009) Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science 4, 50
| Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.Crossref | GoogleScholarGoogle Scholar | 19664226PubMed |
Eccles MP, Mittman BS (2006) Welcome to Implementation Science. Implementation Science 1, 1
| Welcome to Implementation Science.Crossref | GoogleScholarGoogle Scholar |
Farrow M (2010) Dementia risk reduction: a practical guide for general practitioners. (Alzheimer’s Australia: Melbourne, Vic., Australia) Available at http://www.dementia.unsw.edu.au/images/dcrc/pdf/drrgps.pdf [Verified 18 December 2019]
Godbee K, Gunn J, Lautenschlager NT, Curran E, Palmer VJ (2019) Implementing dementia risk reduction in primary care: a preliminary conceptual model based on a scoping review of practitioners’ views. Primary Health Care Research and Development 20, E140
| Implementing dementia risk reduction in primary care: a preliminary conceptual model based on a scoping review of practitioners’ views.Crossref | GoogleScholarGoogle Scholar |
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O (2004) Diffusion of innovations in service organizations: systematic review and recommendations. The Milbank Quarterly 82, 581–629.
| Diffusion of innovations in service organizations: systematic review and recommendations.Crossref | GoogleScholarGoogle Scholar | 15595944PubMed |
G20 Osaka Summit (2019a) G20 Osaka leaders’ declaration. Available at https://www.consilium.europa.eu/media/40124/final_g20_osaka_leaders_declaration.pdf [Verified 18 December 2019]
G20 Osaka Summit (2019b) Okayama declaration of the G20 health ministers. Available at http://www.g20.utoronto.ca/2019/2019-g20-health.html [Verified 18 December 2019]
Lau R, Stevenson F, Ong BN, Dziedzic K, Treweek S, Eldridge S, Everitt H, Kennedy A, Qureshi N, Rogers A, Peacock R, Murray E (2015) Achieving change in primary care – causes of the evidence to practice gap: systematic reviews of reviews. Implementation Science 11, 40
| Achieving change in primary care – causes of the evidence to practice gap: systematic reviews of reviews.Crossref | GoogleScholarGoogle Scholar |
Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, Ballard C, Banerjee S, Burns A, Cohen-Mansfield J (2017) Dementia prevention, intervention, and care. Lancet 390, 2673–2734.
| Dementia prevention, intervention, and care.Crossref | GoogleScholarGoogle Scholar |
Maust D, Malani P (2019) National poll on healthy aging: thinking about brain health. (Institute for Healthcare Policy & Innovation, University of Michigan: Ann Arbor, MI, USA) Available at http://hdl.handle.net/2027.42/149132 [Verified 18 December 2019]
Millard FB, Kennedy RL, Baune BT (2011) Dementia: opportunities for risk reduction and early detection in general practice. Australian Journal of Primary Health 17, 89–94.
| Dementia: opportunities for risk reduction and early detection in general practice.Crossref | GoogleScholarGoogle Scholar | 21616031PubMed |
Nilsen P (2015) Making sense of implementation theories, models and frameworks. Implementation Science; IS 10, 53
| Making sense of implementation theories, models and frameworks.Crossref | GoogleScholarGoogle Scholar | 25895742PubMed |
Pond D, Phillips J, Day J, McNeil K, Evans L, Trollor J, Anstey KJ, Peters R (2019) People with Dementia: A Care Guide for General Practice. (NHMRC Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People (CDPC): Sydney, NSW, Australia) Available at https://cdpc.sydney.edu.au/wp-content/uploads/2019/11/CDPC_PrimaryCareGuide_2019.pdf [Verified 18 December 2019]
Powell BJ, Beidas RS, Lewis CC, Aarons GA, McMillen JC, Proctor EK, Mandell DS (2017) Methods to improve the selection and tailoring of implementation strategies. The Journal of Behavioral Health Services & Research 44, 177–194.
| Methods to improve the selection and tailoring of implementation strategies.Crossref | GoogleScholarGoogle Scholar |
Prince MJ (2015) World Alzheimer report 2015. The global impact of dementia: an analysis of prevalence, incidence, cost and trends. (Alzheimer’s Disease International: London, UK) Available at https://www.alz.co.uk/research/world-report-2015 [Verified 18 December 2019]
Royal Australian College of General Practitioners (RACGP) (2016) Guidelines for preventive activities in general practice, 9th edition. (RACGP: Melbourne, Vic., Australia) Available at https://www.racgp.org.au/download/Documents/Guidelines/Redbook9/17048-Red-Book-9th-Edition.pdf [Verified 18 December 2019]
Ritchie J, Spencer L (1994) Qualitative data analysis for applied policy research. In ‘Analyzing qualitative data’. (Eds A Bryman, B Burgess) pp. 173–194. (Routledge: London, UK)
Waltz TJ, Powell BJ, Matthieu MM, Damschroder LJ, Chinman MJ, Smith JL, Proctor EK, Kirchner JE (2015) Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study. Implementation Science 10, 109
| Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study.Crossref | GoogleScholarGoogle Scholar | 26249843PubMed |
Waltz TJ, Powell BJ, Fernández ME, Abadie B, Damschroder LJ (2019) Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implementation Science 14, 42
| Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions.Crossref | GoogleScholarGoogle Scholar | 31036028PubMed |
World Health Organization (WHO) (2019) Risk reduction of cognitive decline and dementia: WHO guidelines. (WHO: Geneva, Switzerland). Available at https://www.who.int/mental_health/neurology/dementia/guidelines_risk_reduction/en/ [Verified 18 December 2019]
