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Dementia case-finding in hospitals: a qualitative study exploring the views of healthcare professionals in English primary care and secondary care
  1. Anne-Marie Burn1,
  2. Jane Fleming2,
  3. Carol Brayne2,
  4. Chris Fox3,
  5. Frances Bunn1
  1. 1 Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
  2. 2 Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
  3. 3 Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
  1. Correspondence to Dr Anne-Marie Burn; a.burn3{at}herts.ac.uk

Abstract

Objectives In 2012–2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges.

Design Qualitative study involving interviews, focus groups and thematic content analysis.

Setting Primary care and secondary care across six counties in the East of England.

Participants Hospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals.

Results We recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs’ lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding.

Conclusions The study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care services across settings.

  • dementia
  • dementia case-finding
  • cognitive impairment

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors JF, FB, CB, and CF wrote the protocol. A-MB and JF collected the data. A-MB, JF and FB analysed the data. A-MB wrote the first draft of the manuscript and is the corresponding author. All authors contributed to the writing of the manuscript and approved its content.

  • Funding This article paper presents independent research funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research & Care (CLAHRC) East of England, at Cambridgeshire and Peterborough NHS Foundation Trust.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was obtained from The University of Hertfordshire Ethics Committee (HSK/SF/UH/02005).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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