Title : Research on the dilemmas of dementia management based on Integrated Care Theory: From the perspective of community health services center
Abstract:
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 center (CHSC) 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 one CHSC, and five general practitioners and 6 nurses from three CHSCs were interviewed 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 formed 85 preliminary codes, 11 categories, and 4 themes. The themes were respectively: Unavailable clinical services (unavailable drugs for treating dementia, unavailable non-pharmacological interventions for pre-stage and early-stage dementia, lack of dementia case management, and unwilling participation in dementia management of OA and family members); inefficient professional integration (an inefficient multidisciplinary team, the missing role of nurse); uncoordinated organizational integration (uncoordinated functions between CHSC and memory center, lack of benefit sharing mechanism, unstable information sharing systems); and unformed normative integration (the negative management attitudes of CHSC caregivers, and shame towards dementia among OA and CHSC caregivers).
Discussion: The China has been promoting integrated care at the system level. However, the management of CHSC is still in development. The dilemmas 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 the dilemmas of implementing people-centered dementia management from the perspective of CHSC
• The dilemmas 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
