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Right of Way: Using Action Research to Explore New Pathways to Triage for Dementia in Primary Care / RICHARD THOMAS

Swansea University Author: RICHARD THOMAS

  • E-Thesis under embargo until: 28th March 2028

DOI (Published version): 10.23889/SUthesis.63662

Abstract

This longitudinal case-study used an action research approach and critical realist epistemology to explore how the introduction of an electronic app on a smart device can help to triage for changes to cognition in primary care. The app was used by a team of community dementia support workers and was...

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Published: Swansea, Wales, UK 2023
Institution: Swansea University
Degree level: Doctoral
Degree name: Professional Doctorate
Supervisor: Tales, A. and Rich, N.
URI: https://cronfa.swan.ac.uk/Record/cronfa63662
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Those patients found to have clinically significant changes to their cognition were offered further in-depth assessments for dementia, whilst those with no clinically significant changes were offered reassurance and signposted elsewhere. Over two planned programmes of scale-up and spread (undertaken with an independent body that advises Welsh Government on prudent healthcare), the model of triage described here, demonstrated the potential for new pathways to assess and diagnose dementia within primary care. The shifting of care which was previously delivered by specialist services (secondary care) to non-specialists (primary care), is a major breakthrough in terms of increasing the dementia diagnostic rates and is advocated by all the research bodies representing dementia at world level.In one 12-month period alone, just under four hundred people used the triage service aided by an informal open-access referral process and proximity of dementia support workers. The service focussed on helping those people who find it difficult to access conventional memory assessment services, many of whom have multiple co-morbidities and diagnoses. Despite these reported successes and financial support from the regional partnership board (which promotes greater integration of health and social care), the new model met with resistance from some professionals based in older adult mental health services. This led to an irreconcilable breakdown in communication and the service was abruptly terminated thereby forfeiting opportunities for further learning and quality improvement.The study highlighted that from a systems theory background, resistance to change is both systemic and global in nature and that this theory can be used to explain difficulties in adapting practice to fit the dynamic conditions of health need. The study concludes that more transformational interventions to fundamentally change the care system are needed to avoid an inevitable catastrophic failure in the care of vulnerable patients. Furthermore, health professionals must understand the tenets of systems thinking, quality management (including system failure demand) and recognise the high levels of dependency between secondary and primary care services if the optimal allocation of services and staff skills are to be exploited to manage service demand and to drive out system waste. The conclusions reveal that the current model of care for the early identification, assessment and treatment of dementia has significant system inertia and without the catalyst of isomorphic change (endorsement by a professional body for change, recognition of mutual dependency between primary and secondary care providers or a new organisation becomes a benchmark dominant model to emulate) then inertia will remain, and improvements will fail to be exploited for the benefit of patients and the staff delivering care.In summary, multiple interventions were used over five action research learning cycles which explored how a system reacts under pressure to new innovations. 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spelling v2 63662 2023-06-19 Right of Way: Using Action Research to Explore New Pathways to Triage for Dementia in Primary Care 3fb3f07b40cfd69f312f633a939baa87 RICHARD THOMAS RICHARD THOMAS true false 2023-06-19 This longitudinal case-study used an action research approach and critical realist epistemology to explore how the introduction of an electronic app on a smart device can help to triage for changes to cognition in primary care. The app was used by a team of community dementia support workers and was conducted in multiple cluster networks (general practitioner practices). Those patients found to have clinically significant changes to their cognition were offered further in-depth assessments for dementia, whilst those with no clinically significant changes were offered reassurance and signposted elsewhere. Over two planned programmes of scale-up and spread (undertaken with an independent body that advises Welsh Government on prudent healthcare), the model of triage described here, demonstrated the potential for new pathways to assess and diagnose dementia within primary care. The shifting of care which was previously delivered by specialist services (secondary care) to non-specialists (primary care), is a major breakthrough in terms of increasing the dementia diagnostic rates and is advocated by all the research bodies representing dementia at world level.In one 12-month period alone, just under four hundred people used the triage service aided by an informal open-access referral process and proximity of dementia support workers. The service focussed on helping those people who find it difficult to access conventional memory assessment services, many of whom have multiple co-morbidities and diagnoses. Despite these reported successes and financial support from the regional partnership board (which promotes greater integration of health and social care), the new model met with resistance from some professionals based in older adult mental health services. This led to an irreconcilable breakdown in communication and the service was abruptly terminated thereby forfeiting opportunities for further learning and quality improvement.The study highlighted that from a systems theory background, resistance to change is both systemic and global in nature and that this theory can be used to explain difficulties in adapting practice to fit the dynamic conditions of health need. The study concludes that more transformational interventions to fundamentally change the care system are needed to avoid an inevitable catastrophic failure in the care of vulnerable patients. Furthermore, health professionals must understand the tenets of systems thinking, quality management (including system failure demand) and recognise the high levels of dependency between secondary and primary care services if the optimal allocation of services and staff skills are to be exploited to manage service demand and to drive out system waste. The conclusions reveal that the current model of care for the early identification, assessment and treatment of dementia has significant system inertia and without the catalyst of isomorphic change (endorsement by a professional body for change, recognition of mutual dependency between primary and secondary care providers or a new organisation becomes a benchmark dominant model to emulate) then inertia will remain, and improvements will fail to be exploited for the benefit of patients and the staff delivering care.In summary, multiple interventions were used over five action research learning cycles which explored how a system reacts under pressure to new innovations. The findings might therefore be relevant to other sites and although limited in its scope, can contribute to a deeper academic understanding of the barriers and enablers to change. E-Thesis Swansea, Wales, UK Dementia, Triage, Primary care, Memory assessment, Community 28 3 2023 2023-03-28 10.23889/SUthesis.63662 A selection of content is redacted or is partially redacted from this thesis to protect sensitive and personal information. COLLEGE NANME COLLEGE CODE Swansea University Tales, A. and Rich, N. Doctoral Professional Doctorate NHS Wales Subject keywords 2023-10-03T15:59:48.4502711 2023-06-19T11:22:03.5379555 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Nursing RICHARD THOMAS 1 Under embargo Under embargo 2023-06-19T11:30:17.3835412 Output 4328735 application/pdf E-Thesis true 2028-03-28T00:00:00.0000000 Copyright: The Author, Richard C. Thomas, 2023. Distributed under the terms of a Creative Commons Attribution-NonCommercial 4.0 License (CC BY-NC 4.0). true eng https://creativecommons.org/licenses/by-nc/4.0/
title Right of Way: Using Action Research to Explore New Pathways to Triage for Dementia in Primary Care
spellingShingle Right of Way: Using Action Research to Explore New Pathways to Triage for Dementia in Primary Care
RICHARD THOMAS
title_short Right of Way: Using Action Research to Explore New Pathways to Triage for Dementia in Primary Care
title_full Right of Way: Using Action Research to Explore New Pathways to Triage for Dementia in Primary Care
title_fullStr Right of Way: Using Action Research to Explore New Pathways to Triage for Dementia in Primary Care
title_full_unstemmed Right of Way: Using Action Research to Explore New Pathways to Triage for Dementia in Primary Care
title_sort Right of Way: Using Action Research to Explore New Pathways to Triage for Dementia in Primary Care
author_id_str_mv 3fb3f07b40cfd69f312f633a939baa87
author_id_fullname_str_mv 3fb3f07b40cfd69f312f633a939baa87_***_RICHARD THOMAS
author RICHARD THOMAS
author2 RICHARD THOMAS
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hierarchy_top_title Faculty of Medicine, Health and Life Sciences
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department_str School of Health and Social Care - Nursing{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Nursing
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description This longitudinal case-study used an action research approach and critical realist epistemology to explore how the introduction of an electronic app on a smart device can help to triage for changes to cognition in primary care. The app was used by a team of community dementia support workers and was conducted in multiple cluster networks (general practitioner practices). Those patients found to have clinically significant changes to their cognition were offered further in-depth assessments for dementia, whilst those with no clinically significant changes were offered reassurance and signposted elsewhere. Over two planned programmes of scale-up and spread (undertaken with an independent body that advises Welsh Government on prudent healthcare), the model of triage described here, demonstrated the potential for new pathways to assess and diagnose dementia within primary care. The shifting of care which was previously delivered by specialist services (secondary care) to non-specialists (primary care), is a major breakthrough in terms of increasing the dementia diagnostic rates and is advocated by all the research bodies representing dementia at world level.In one 12-month period alone, just under four hundred people used the triage service aided by an informal open-access referral process and proximity of dementia support workers. The service focussed on helping those people who find it difficult to access conventional memory assessment services, many of whom have multiple co-morbidities and diagnoses. Despite these reported successes and financial support from the regional partnership board (which promotes greater integration of health and social care), the new model met with resistance from some professionals based in older adult mental health services. This led to an irreconcilable breakdown in communication and the service was abruptly terminated thereby forfeiting opportunities for further learning and quality improvement.The study highlighted that from a systems theory background, resistance to change is both systemic and global in nature and that this theory can be used to explain difficulties in adapting practice to fit the dynamic conditions of health need. The study concludes that more transformational interventions to fundamentally change the care system are needed to avoid an inevitable catastrophic failure in the care of vulnerable patients. Furthermore, health professionals must understand the tenets of systems thinking, quality management (including system failure demand) and recognise the high levels of dependency between secondary and primary care services if the optimal allocation of services and staff skills are to be exploited to manage service demand and to drive out system waste. The conclusions reveal that the current model of care for the early identification, assessment and treatment of dementia has significant system inertia and without the catalyst of isomorphic change (endorsement by a professional body for change, recognition of mutual dependency between primary and secondary care providers or a new organisation becomes a benchmark dominant model to emulate) then inertia will remain, and improvements will fail to be exploited for the benefit of patients and the staff delivering care.In summary, multiple interventions were used over five action research learning cycles which explored how a system reacts under pressure to new innovations. The findings might therefore be relevant to other sites and although limited in its scope, can contribute to a deeper academic understanding of the barriers and enablers to change.
published_date 2023-03-28T15:59:49Z
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