Supporting primary care practitioners to promote dementia risk reduction in Australian general practice: outcomes of a cross-sectional, non-randomised implementation pilot study

Kali Godbee; Victoria J. Palmer; Jane M. Gunn; Nicola T. Lautenschlager; Jill J. Francis

doi:10.1071/PY24063

RESEARCH ARTICLE (Open Access)

Supporting primary care practitioners to promote dementia risk reduction in Australian general practice: outcomes of a cross-sectional, non-randomised implementation pilot study

Kali Godbee ^A ^* , Victoria J. Palmer ^A ^B , Jane M. Gunn ^B ^C , Nicola T. Lautenschlager ^B ^D ^E and Jill J. Francis ^F ^G

+ Author Affiliations

- Author Affiliations

^A Department of General Practice and Primary Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia.

^B The ALIVE National Centre for Mental Health Research Translation, The University of Melbourne, Melbourne, Vic, Australia.

^C Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia.

^D Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia.

^E Older Adult Mental Health Program, Royal Melbourne Hospital Mental Health Service, Parkville, Vic, Australia.

^F Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia.

^G Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.

^* Correspondence to: kaligodbee@gmail.com

Australian Journal of Primary Health 30, PY24063 https://doi.org/10.1071/PY24063

Submitted: 11 May 2024 Accepted: 13 September 2024 Published: 30 September 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Primary care practitioners worldwide are urged to promote dementia risk reduction as part of preventive care. To facilitate this in Australian primary care, we developed the Umbrella intervention, comprising a waiting room survey and patient information cards for use in consultations. Educational and relational strategies were employed to mitigate implementation barriers.

Methods

In this cross-sectional, non-randomised implementation study within the South East Melbourne Primary Health Network, we employed mixed-methods outcome evaluation. Antecedent outcomes (acceptability, appropriateness, and feasibility) and actual outcomes (adoption, penetration, and fidelity) were assessed from the perspective of primary care practitioners and patients.

Results

Five practices piloted the intervention and implementation strategies, including 16 primary care practitioners engaging with 159 patients. The Umbrella intervention was deemed acceptable, appropriate, and feasible, but penetration was limited. Approximately half of eligible primary care practitioners used the intervention, with moderate fidelity. Engagement with implementation strategies was similarly limited. While most strategies were well-received, improvements in online peer discussions and staff readiness were desired.

Conclusions

The Umbrella intervention is a viable approach to promoting dementia risk reduction in Australian general practice, supported by educational and relational strategies. Stakeholder-informed refinements to enhance uptake are recommended before advancing to a definitive trial.

Keywords: dementia, general practice, general practice nurses, general practitioners, Implementation Outcomes Framework, implementation science, pilot study, preventive health, primary care, risk reduction.

References

Australian Institute of Health and Welfare (2021) Practice incentives program quality improvement measures: national report on the first year of data 2020-21. (AIHW: Canberra, ACT, Australia) Available at https://www.aihw.gov.au/reports/primary-health-care/pipqi-measures-national-report-2020-21 [verified 10 May 2024]

Damschroder LJ, Reardon CM, Opra Widerquist MA, Lowery J (2022) Conceptualizing outcomes for use with the Consolidated Framework for Implementation Research (CFIR): the CFIR Outcomes Addendum. Implementation Science 17(1), 7.
| Crossref | Google Scholar | PubMed |

Godbee K (2024) Supporting primary care practitioners to promote dementia risk reduction in Australian general practice: development and pilot evaluation of a practice change intervention and targeted implementation approach. PhD Thesis, University of Melbourne, Vic, Australia.

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 & Development 20, e140.
| Crossref | Google Scholar | PubMed |

Godbee K, Gunn J, Lautenschlager NT, Palmer VJ (2020) Refined conceptual model for implementing dementia risk reduction: incorporating perspectives from Australian general practice. Australian Journal of Primary Health 26(3), 247-255.
| Crossref | Google Scholar | PubMed |

Godbee K, Farrow M, Bindoff A, Gunn J, Lautenschlager N, Palmer V (2021) Implementing dementia risk reduction in primary care: views of enrollees in the Preventing Dementia Massive Open Online Course. Australian Journal of Primary Health 27(6), 479-484.
| Crossref | Google Scholar | PubMed |

Godbee K, Guccione L, Palmer VJ, Gunn J, Lautenschlager N, Francis JJ (2022) Dementia risk reduction in primary care: a scoping review of clinical guidelines using a behavioral specificity framework. Journal of Alzheimer’s Disease 89(3), 789-802.
| Crossref | Google Scholar | PubMed |

Goodyear-Smith F, Warren J, Bojic M, Chong A (2013) eCHAT for lifestyle and mental health screening in primary care. Annals of Family Medicine 11(5), 460-466.
| Crossref | Google Scholar | PubMed |

Hsieh H-F, Shannon SE (2005) Three approaches to qualitative content analysis. Qualitative Health Research 15(9), 1277-1288.
| Crossref | Google Scholar | PubMed |

Huybrechts I, Declercq A, Verte E, Raeymaeckers P, Anthierens S (2021) The building blocks of implementation frameworks and models in primary care: a narrative review. Frontiers in Public Health 9, 675171.
| Crossref | Google Scholar |

Livingston G, Huntley J, Liu KY, Costafreda SG, Selbæk G, Alladi S, Ames D, Banerjee S, Burns A, Brayne C, Fox NC, Ferri CP, Gitlin LN, Howard R, Kales HC, Kivimäki M, Larson EB, Nakasujja N, Rockwood K, Samus Q, Shirai K, Singh-Manoux A, Schneider LS, Walsh S, Yao Y, Sommerlad A, Mukadam N (2024) Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet 404(10452), 572-628.
| Crossref | Google Scholar |

MBS Review Advisory Committee (2024) Telehealth post-implementation review: final report. (MBS Review Advisory Committee) Available at https://www.health.gov.au/sites/default/files/2024-06/mbs-review-advisory-committee-telehealth-post-implementation-review-final-report.pdf [verified 17 August 2024]

Mostofian F, Ruban C, Simunovic N, Bhandari M (2015) Changing physician behavior: what works? American Journal of Managed Care 21(1), 75-84.
| Google Scholar | PubMed |

NHS Health Check (2017) NHS health check top tips: talking about dementia. Available at https://www.healthcheck.nhs.uk/seecmsfile/?id=247 [verified 10 May 2024]

Pinnock H, Barwick M, Carpenter CR, Eldridge S, Grandes G, Griffiths CJ, Rycroft-Malone J, Meissner P, Murray E, Patel A, Sheikh A, Taylor SJC, Sta RIG (2017) Standards for Reporting Implementation Studies (StaRI): explanation and elaboration document. BMJ Open 7(4), e013318.
| Crossref | Google Scholar | PubMed |

Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M (2011) Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research 38(2), 65-76.
| Crossref | Google Scholar | PubMed |

Public Health Information Development Unit (2019) Social health atlas of Australia: population health areas. Available at http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-population-health-areas [Verified 10 May 2024]

Rogers EM (2003) ‘Diffusion of innovations.’ 5th edn. (Free Press: New York, NY, USA)

Sekhon M, Cartwright M, Francis JJ (2017) Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Services Research 17(1), 88.
| Crossref | Google Scholar | PubMed |

Solutions Strategy Research Facilitation Ltd and Cornish and Grey Ltd (2017) NHS Health Check 40-64 Dementia Pilot: Research Findings. Summary research report. Available at https://www.alzheimersresearchuk.org/wp-content/uploads/2017/08/Solutions-Dementia-Pilot-Summary-Report-Final-24.7.17-1.pdf [verified 10 May 2024]

Toomey E, Matthews J, Hurley DA (2017) Using mixed methods to assess fidelity of delivery and its influencing factors in a complex self-management intervention for people with osteoarthritis and low back pain. BMJ Open 7(8), e015452.
| Crossref | Google Scholar | PubMed |

Waltz TJ, Powell BJ, Matthieu MM, Damschroder LJ, Chinman MJ, Smith JL, Proctor EK, Kirchner JAE (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(1), 109.
| Crossref | Google Scholar |

Zheng L, Godbee K, Steiner GZ, Daylight G, Ee C, Hill TY, Hohenberg MI, Lautenschlager NT, McDonald K, Pond D, Radford K, Anstey KJ, Peters R (2021) Dementia risk reduction in practice: the knowledge, opinions and perspectives of Australian healthcare providers. Australian Journal of Primary Health 27(2), 136-142.
| Crossref | Google Scholar |