Title : Research on challenges of dementia management based on Integrated Care Theory: From the perspective of community health services centers
Background: The number of older adults (OA) with dementia is increasing in China and worldwide. Integrated, people-centered health services emphasizes establishing a strong primary health care system which provides the first-contact health service thus plays a very important role in dementia management. However, the development of dementia management in community health services centers (CHSCs) is not clear.
Method: A 2-month filed research that included semi-participatory observations and in-depth interviews was conducted in three CHSCs in Suzhou, China, from February to March 2023. The dementia care related work was observed in three CHSC, and 14 service providers, including general practitioners, nurses, etc. were interviewed and observed using purposive sampling. The Rainbow model was used as the coding framework. Field notes, interview text, and other data were analyzed by content analysis method. Nvivo 12 was applied in this analysis.
Results: This study identified 13 Challenges, respectively six, five and two challenges in organizational, professional and clinical integration dimension. For organizational level, identified challenges included Lack of social institutions in CHSCs-led screening, Not fully exerted function of MC, Uncoordinated functions between CHSC and memory center/Specialist clinic from tertiary hospital, Lack of benefit sharing mechanism, Unstable information sharing systems, and Goals stuck in the agreement. For professional level, identified challenges included Insufficient joint effort within health care providers, Unformed MDT between CHCSs and DSCs, No detailed professional service norms, Lack of performance evaluation, and The negative attitudes of professionals in CHSCs. For clinical level, identified challenges included Not involved a single or coherent process and Unwilling participation.
Discussion: The China has been promoting integrated care at the system level. However, the management of CHSC is still in development. The challenges and related reasons found in this study has a guiding role for policymakers and practitioner of dementia health services to further develop effective policy and strategies.
Audience Take Away Notes:
- Learn how to conduct field research in Nursing research, especially those related to social science research
- Understand challenges of implementing people-centered dementia management from the perspective of CHSC
- The challenges identified in this study were enlightening for improving dementia management strategies
- Encourage audience to further reflect on the integrated care in dementia older adults in their country and promote their research