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Improving the quality of care for mild to moderate dementia: an evaluation of the Croydon Memory Service Model
- Authors:
- BANERJEE Sube, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(8), August 2007, pp.782-788.
- Publisher:
- Wiley
The large majority of people with dementia receive nothing in the way of specialist assessment and care at any stage of their illness. There is a particular lack of services focussed on early identification and intervention in dementia where there is the possibility of long-term harm reduction for people with dementia and their family carers. The authors have developed a model of care that is complementary to local systems of health and social care (The Croydon Memory Service Model [CMSM]). This is a low-cost, high-throughput, generic service to enable early identification and intervention in dementia. It is a multi-agency approach with joint ownership by health services, social services and the voluntary sector with embedded specifically-tailored approaches to primary care and minority ethnic communities. This article presents the findings of a service evaluation of the introduction of the CMSM in a single borough in South London. Six predefined service goals were set: high acceptability; high appropriate referral rate; successful engagement with people from minority ethnic groups; successful engagement with people with young onset dementia; focus on engagement with mild cases to enable early intervention; and an increase in the overall number of new cases of dementia seen. Mixed qualitative and quantitative methodologies were used including a description and 6-month follow-up of a cohort of 290 consecutive referrals. All key predefined service goals were met: 95% acceptability; 94% appropriate referrals; successful engagement with minority ethnic groups (two-fold greater number compared with that expected from general population demographic data); 17% of referrals under 65 years of age; 68% referrals with mild or minimal dementia severity; and an estimated 63% increase in the number of new cases of dementia seen in Croydon. At 6-month follow up, those referred to the service had decreased behavioural disturbance and increased quality of life compared with baseline. It is concluded that specific services for early dementia, which deliver diagnosis and care, can be established. These services can increase the numbers of people with early dementia identified and provided with care. Those receiving such services appear to improve in terms of quality of life and behavioural and psychological symptoms of dementia.
The Stroud/ADI dementia quality framework: a cross-national population-level framework for assessing the quality of life impacts of services and policies for people with dementia and their family carers
- Authors:
- BANERJEE Sube, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(3), March 2010, pp.249-257.
- Publisher:
- Wiley
This paper aims to generate an internationally applicable framework for the systematic assessment of the quality of life impacts of services and policies for older people with dementia and their family carers. Based on a qualitative analysis of text, derived from open groups at six consecutive ‘Alzheimer's Disease International’ (ADI) Conferences (1999-2005), the 312 textual contributions included: presenters texts; transcribed points made during discussion; and written contributions. The results showed that eight interacting domains relating to quality of life emerged: Public Attitudes and Understanding; Government and Social Policy; Funding for Services; Health; Communication; Choice and Personhood; Environment; and Quality of Care leading to the development of the Stroud/ADI Dementia Quality Framework. In conclusion the authors assert that the Stroud/ADI Dementia Quality Framework helps to structure the assessment of the quality of life impacts of population level approaches in dementia impacts. Available information can be mapped onto the framework. With its international approach, the Stroud/ADI Dementia Quality Framework has validity across cultures and across countries. It is intended as a useful aid for the assessment of services and policies for people with dementia and their family carers.
Clinical and cost effectiveness of services for early diagnosis and intervention in dementia
- Authors:
- BANERJEE Sube, WITTENBERG Raphael
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(7), July 2009, pp.748-754.
- Publisher:
- Wiley
This paper analyses the costs and benefits of commissioning memory services for early diagnosis and intervention for dementia. A model was developed to examine potential public and private savings associated with delayed admissions to care homes in England as a result of the commissioning of memory services. The new services would cost around £220 million extra per year nationally in England. The estimated savings if 10% of care home admissions were prevented would by year 10 be around £120 million in public expenditure (social care) and £125 million in private expenditure (service users and their families), a total of £245 million. Under a 20% reduction, the annual cost would within around 6 years be offset by the savings to public funds alone. In 10 years all people with dementia will have had the chance to be seen by the new services. A gain of between 0.01 and 0.02 QALYs per person year would be sufficient to render the service cost-effective (in terms of positive net present value). These relatively small improvements seem very likely to be achievable. These analyses suggest that the service need only achieve a modest increase in average quality of life of people with dementia, plus a 10% diversion of people with dementia from residential care, to be cost-effective. The net increase in public expenditure would then, on the assumptions discussed and from a societal perspective, be justified by the expected benefits. This modelling presents for debate support for the development of nationwide services for the early identification and treatment of dementia in terms of quality of life and overall cost-effectiveness.