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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE (Open Access)

Mobile memory clinic: implementing a nurse practitioner-led, collaborative dementia model of care within general practice

Dimity Pond https://orcid.org/0000-0001-6520-4213 A G , Isabel Higgins B , Karen Mate C , Helga Merl D , Dianne Mills E and Karen McNeil F
+ Author Affiliations
- Author Affiliations

A School of Medicine and Public Health, Office 134, The Building and Investment Centre of Excellence, University of Newcastle, 10 Chittaway Road, Ourimbah, NSW 2258, Australia.

B School of Nursing and Midwifery, RW227, Richardson Wing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.

C School of Biomedical Sciences and Pharmacy, LS350, Life Sciences Building, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.

D Hunter New England Local Health District and Hunter Medicare Local. Present address: Wicking Dementia Research and Education Centre, Room B128, University of Tasmania, Private Bag 143, Hobart, Tas. 7001, Australia.

E Aged Care and Rehabilitation Services (LMNCS), Hunter New England Health District, Building 2, Level 1, 26 York Street, Taree, NSW 2430, Australia.

F School of Medicine and Public Health, Office 134, The Building and Investment Centre of Excellence, University of Newcastle, 10 Chittaway Road, Ourimbah, NSW 2258, Australia.

G Corresponding author. Email: Dimity.Pond@newcastle.edu.au

Australian Journal of Primary Health 27(1) 6-12 https://doi.org/10.1071/PY20118
Submitted: 14 May 2020  Accepted: 16 October 2020   Published: 1 February 2021

Journal Compilation © La Trobe University 2021 Open Access CC BY-NC

Abstract

The limited capacity of secondary health services to address the increasing prevalence of dementia within the community draws attention to the need for an enhanced role for nurses working collaboratively with GPs in diagnosing and coordinating post-diagnostic care for patients with dementia. This study investigated the feasibility and acceptability of a nurse practitioner-led mobile memory clinic that was embedded within general practice and targeted to caring for patients and their carers in areas of socioeconomic disadvantage with poor access to specialist health services. Over the period from mid-2013 to mid-2014, 40 GPs referred 102 patients, with the nurse practitioner conducting assessments with 77 of these patients in their homes. Overall, there was a strong interest in this model of care by general practice staff, with the assessment and care provided by the nurse practitioner evaluated as highly acceptable by both patients and their carers. Nonetheless, there are financial and structural impediments to this model of care being implemented within the current Australian health service framework, necessitating further research investigating its cost-effectiveness and efficacy.

Keywords: dementia, GPs, home-based assessment, multidisciplinary care, nurse practitioners.


References

Alexopoulos GS, Abrams RC, Young RC, Shamoian CA (1988) Cornell scale for depression in dementia. Biological Psychiatry 23, 271–284.

Aminzadeh F, Molnar FJ, Dalziel WB, Ayotte D (2012) A review of barriers and enablers to diagnosis and management of persons with dementia in primary care. Canadian Geriatrics Journal 15, 85–94.
A review of barriers and enablers to diagnosis and management of persons with dementia in primary care.Crossref | GoogleScholarGoogle Scholar | 23259021PubMed |

Bucks RS, Ashworth DL, Wilcock GK, Siegfried K (1996) Assessment of Activities of Daily Living in Dementia: Development of the Bristol Activities of Daily Living Scale. Age and Ageing 25, 113–120.

Byrne GJ, Pachana NA (2011) Development and validation of a short form of the Geriatric Anxiety Inventory – the GAI-SF. International Psychogeriatrics 23, 125–131.
Development and validation of a short form of the Geriatric Anxiety Inventory – the GAI-SF.Crossref | GoogleScholarGoogle Scholar | 20561386PubMed |

Carver CS (1997) You want to measure coping but your protocol’s too long: consider the brief cope. International Journal of Behavioral Medicine 4, 92–100.

Clark S, Parker R, Prosser B, Davey R (2013) Aged care nurse practitioners in Australia: evidence for the development of their role. Australian Health Review 37, 594–601.
Aged care nurse practitioners in Australia: evidence for the development of their role.Crossref | GoogleScholarGoogle Scholar | 24176166PubMed |

Convery P, Pond D, Goode S (2013) A feasibility study of a nursing intervention to assist general practitioners with best practice identification and management of dementia. (University of NSW, Dementia Research Collaborative Centre: Sydney, NSW, Australia) Available at http://www.dementiaresearch.org.au/images/dcrc/output-files/629-digp5_report.pdf [Verified 10 May 2020]

Currie J, Chiarella M, Buckley T (2016) Workforce characteristics of privately practicing nurse practitioners in Australia: results from a national survey. Journal of the American Association of Nurse Practitioners 28, 546–553.
Workforce characteristics of privately practicing nurse practitioners in Australia: results from a national survey.Crossref | GoogleScholarGoogle Scholar | 27215578PubMed |

Davey, R, Clark, S, Goss, J, Parker, R, Hungerford, C, Gibson, D (2015) National Evaluation of the nurse practitioner — aged care models of practice initiative: summary of findings. (Centre for Research & Action in Public Health, UC Health Research Institute, University of Canberra: Canberra, ACT, Australia) Available at https://researchoutput.csu.edu.au/ws/portalfiles/portal/19842075 [Verified 11 May 2020]

Dementia Australia (2020) Dementia statistics. (Dementia Australia: Canberra, ACT, Australia) Available at https://www.dementia.org.au/statistics [Verified 22 January 2020]

Dodd E, Cheston R, Ivanecka A (2015) The assessment of dementia in primary care. Journal of Psychiatric and Mental Health Nursing 22, 731–737.
The assessment of dementia in primary care.Crossref | GoogleScholarGoogle Scholar | 26459923PubMed |

Ervin K, Reid C, Moran A, Opie C, Haines H (2019) Implementation of an older person’s nurse practitioner in rural aged care in Victoria, Australia: a qualitative study. Human Resources for Health 17, 80
Implementation of an older person’s nurse practitioner in rural aged care in Victoria, Australia: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 31675960PubMed |

Haines HM, Critchley J (2009) Developing the nurse practitioner role in a rural Australian hospital: a Delphi study of practice opportunities, barriers and enablers. The Australian Journal of Advanced Nursing 27, 30–36.

Helms C, Crookes J, Bailey D (2015) Financial viability, benefits and challenges of employing a nurse practitioner in general practice. Australian Health Review 39, 205–210.
Financial viability, benefits and challenges of employing a nurse practitioner in general practice.Crossref | GoogleScholarGoogle Scholar | 25528465PubMed |

Koch T, Iliffe S (2010) Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: a systematic review. BMC Family Practice 11, 52
Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: a systematic review.Crossref | GoogleScholarGoogle Scholar | 20594302PubMed |

Koshy E, Koshy V, Waterman H (2010) ‘Action research in healthcare.’ (SAGE Publications: London, UK)

KPMG (2018) Cost benefit analysis of nurse practitioner models of care. Department of Health November 2018 report. Available at https://www1.health.gov.au/internet/main/publishing.nsf/Content/424787040165EBABCA258470001C35EE/$File/Cost%20Benefit%20Analysis%20of%20Nurse%20Practitioner%20Models%20of%20Care%20report.pdf [Verified 14 April 2020]

Logsdon RG, Gibbons LE, McCurry SM, Teri L (2002) Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine 64, 510–519.

Lovibond PF, Lovibond SH (1995) The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behaviour Research and Therapy 33, 335–343.
The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories.Crossref | GoogleScholarGoogle Scholar | 7726811PubMed |

MacLellan L, Higgins I, Levett-Jones T (2015) Medical acceptance of the nurse practitioner role in Australia: a decade on. Journal of the American Association of Nurse Practitioners 27, 152–159.

Maier CB, Aiken LH (2016) Task shifting from physicians to nurses in primary care in 39 countries: a cross-country comparative study. European Journal of Public Health 26, 927–934.
Task shifting from physicians to nurses in primary care in 39 countries: a cross-country comparative study.Crossref | GoogleScholarGoogle Scholar | 27485719PubMed |

Mason R, Doherty K, Eccleston C, Winbolt M, Long M, Robinson A (2020) Effect of a dementia education intervention on the confidence and attitudes of general practitioners in Australia: a pretest post-test study. BMJ Open 10, e033218
Effect of a dementia education intervention on the confidence and attitudes of general practitioners in Australia: a pretest post-test study.Crossref | GoogleScholarGoogle Scholar | 33323442PubMed |

Medicare Benefits Schedule Review Taskforce (2018) Report from the nurse practitioner reference group. (Department of Health: Canberra, ACT, Australia) Available at https://www1.health.gov.au/internet/main/publishing.nsf/content/BEB6C6D36DE56438CA258397000F4898/$File/NPRG%20Final%20Report%20-%20v2.pdf [Verified 21 December 2020]

Minstrell M, Bentley M, Bucher H, Morrissey M, Higgs C, Robinson A, Stirling C (2015) Open referral policy within a nurse-led memory clinic: patient demographics, assessment scores, and diagnostic profiles. International Psychogeriatrics 27, 967–979.
Open referral policy within a nurse-led memory clinic: patient demographics, assessment scores, and diagnostic profiles.Crossref | GoogleScholarGoogle Scholar | 25483359PubMed |

Nursing and Midwifery Board of Australia (2016) Registration standard: endorsement as a nurse practitioner. (AHPRA: Canberra, ACT, Australia) Available at https://www.nursingmidwiferyboard.gov.au/registration-standards/endorsement-as-a-nurse-practitioner.aspx [Verified 21 December 2020]

Pond CD (2017) The role of primary care in identification and ongoing management of dementia: a time of transition. International Psychogeriatrics 29, 1409–1411.
The role of primary care in identification and ongoing management of dementia: a time of transition.Crossref | GoogleScholarGoogle Scholar | 28701239PubMed |

Pond CD, Mate KE, Phillips J, Stocks NP, Magin PJ, Weaver N, Brodaty H (2013) Predictors of agreement between general practitioner detection of dementia and the revised Cambridge Cognitive Assessment (CAMCOG-R). International Psychogeriatrics 25, 1639–1647.
Predictors of agreement between general practitioner detection of dementia and the revised Cambridge Cognitive Assessment (CAMCOG-R).Crossref | GoogleScholarGoogle Scholar | 23800652PubMed |

Prince M, Comas-Herrera A, Knapp PM, Guerchet M, Karagiannidou M (2016) ‘World Alzheimer report 2016: improving healthcare for people living with dementia coverage.’ (ADI: London, UK)

Reuben DB, Ganz DA, Roth CP, McCreath HE, Ramirez KD, Wenger NS (2013) Effect of nurse practitioner comanagement on the care of geriatric conditions. Journal of the American Geriatrics Society 61, 857–867.
Effect of nurse practitioner comanagement on the care of geriatric conditions.Crossref | GoogleScholarGoogle Scholar | 23772723PubMed |

Roth M, Huppert FA, Mountjoy CQ, Tym E (1988) ‘CAMDEX: the Cambridge Examination for Mental Disorders of the Elderly.’ (Cambridge University Press: Cambridge, UK)

Swerissen H, Duckett S, Moran G (2018) Mapping primary care in Australia. Available at https://grattan.edu.au/wp-content/uploads/2018/07/906-Mapping-primary-care.pdf [Verified 1 November 2020]

Tilburgs B, Vernooij-Dassen M, Koopmans R, van Gennip H, Engels Y, Perry M (2018) Barriers and facilitators for GPs in dementia advance care planning: a systematic integrative review. PLoS One 13, e0198535
Barriers and facilitators for GPs in dementia advance care planning: a systematic integrative review.Crossref | GoogleScholarGoogle Scholar | 29924837PubMed |

Wendrich-van Dael A, Bunn F, Lynch J, Pivodic L, Van den Block L, Goodman C (2020) Advance care planning for people living with dementia: an umbrella review of effectiveness and experiences. International Journal of Nursing Studies 107, 103576
Advance care planning for people living with dementia: an umbrella review of effectiveness and experiences.Crossref | GoogleScholarGoogle Scholar | 32380259PubMed |

Woods B, Arosio F, Diaz A, Gove D, Holmerová I, Kinnaird L, Mátlová M, Okkonen E, Possenti M, Roberts J (2019) Timely diagnosis of dementia? Family carers’ experiences in 5 European countries. International Journal of Geriatric Psychiatry 34, 114–121.
Timely diagnosis of dementia? Family carers’ experiences in 5 European countries.Crossref | GoogleScholarGoogle Scholar | 30246266PubMed |

World Health Organization (WHO) (2007) Task shifting to tackle health worker shortage. Available at https://www.who.int/healthsystems/task_shifting_booklet.pdf [Verified 20 July 2020]

World Health Organization (WHO) (2020) WHOQOL: measuring quality of life.’ Available at https://www.who.int/tools/whoqol/whoqol-bref/docs/default-source/publishing-policies/whoqol-bref/english-australian-whoqol-bref [Verified 10 May 2020]

Zarit S, Reever K, Bach-Peterson J (1980) Relatives of impaired elderly: correlates of feelings of burden. Gerontologist 20, 373–377.