Abstract
Background
People with dementia and their informal carers often do not receive appropriate professional support or it is not received at the right time.
Objectives
Description and comparison of common pathways to formal community dementia care in eight European countries as a part of the transnational Actifcare project.
Materials and methods
The German team was responsible for creating an individual case scenario as a starting point. The research teams in Ireland, Italy, the Netherlands, Norway, Portugal, Sweden, and the United Kingdom were then asked to describe a common pathway to formal dementia care by writing their own vignette using the provided individual case scenario.
Results
A transnational qualitative content analysis was used to identify the following categories as being the most important: involved professionals, dementia-specific and team-based approaches, proactive roles, and financial aspects. General practitioners (GPs) are described as being the most important profession supporting the access to formal care in all the involved countries. In some countries other professionals take over responsibility for the access procedure. Dementia-specific approaches are rarely part of standard care; team-based approaches have differing significances in each of the countries. Informal carers are mainly proactive in seeking formal care. The Nordic countries demonstrate how financial support enhances access to the professional system.
Conclusion
Enhanced cooperation between GPs and other professions might optimize access to formal dementia care. Team-based approaches focusing on dementia care should be developed further. Informal carers should be supported and relieved in their role. Financial barriers remain which should be further investigated and reduced.
Zusammenfassung
Hintergrund
Menschen mit Demenz und ihre Angehörigen erhalten häufig nicht oder nicht rechtzeitig angemessene professionelle Unterstützung.
Ziel der Arbeit
Beschrieben und verglichen werden Zugangswege zu professioneller ambulanter Unterstützung bei Demenz in acht europäischen Ländern als Teil des transnationalen Actifcare-Projekts.
Material und Methode
Das für das Arbeitspaket verantwortliche Team aus Deutschland erstellte eine Fallvignette als Prototyp; die wissenschaftlichen Teams in Irland, Italien, den Niederlanden, Norwegen, Portugal, Schweden und Großbritannien erhielten den Auftrag, darauf aufbauend den typischen Zugangsweg zu professioneller Unterstützung bei Demenz in einer individuellen Vignette fortzuschreiben.
Ergebnisse
Mit einer länderübergreifenden qualitativen Inhaltsanalyse wurden als wesentliche Kategorien identifiziert: involvierte Professionen, demenzspezifische und teambasierte Ansätze, proaktive Rollen und finanzielle Aspekte. Als die wichtigste Profession im Zugang zu professioneller Unterstützung wird in allen Ländern der Hausarzt beschrieben. In einigen Ländern übernehmen andere Professionen Verantwortung im Zugangsprozess. Demenzspezifische Strukturen sind kaum Bestandteil der Regelversorgung; teambasierte Ansätze sind in den meisten Ländern unterschiedlich bedeutsam etabliert. Angehörige kümmern sich oft in Eigeninitiative darum, professionelle Hilfen einzubeziehen. Die nordischen Länder zeigen, wie sich durch finanzielle Unterstützung der Zugang zum professionellen System fördern lässt.
Schlussfolgerung
Eine intensivierte Zusammenarbeit zwischen Hausärzten und anderen Professionen könnte den Zugang optimieren. Teambasierte Ansätze sind demenzspezifisch weiterzuentwickeln. Angehörige sind in ihrer Rolle zu unterstützen und zu entlasten. Finanzielle Zugangshürden sind genauer zu identifizieren und zu reduzieren.
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A. Bieber, A. Stephan, H. Verbeek, F. Verhey, L. Kerpershoek, C. Wolfs, M. de Vugt, R.T. Woods, J. Røsvik, G. Selbaek, B.M. Sjölund, A. Wimo, L. Hopper, K. Irving, M. Marques, M. Gonçalves-Pereira, E. Portolani, O. Zanetti and G. Meyer declare that they have no competing interests.
This article does not contain any studies with human participants or animals performed by any of the authors.
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391_2017_1266_MOESM2_ESM.docx
Supplementary Material 1 presents information on the described structures and components related to access to formal care and an excerpt of the described structures. Supplementary Material 2 comprises the introduction to the case scenario as the starting point for national common pathways to formal dementia care.
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Bieber, A., Stephan, A., Verbeek, H. et al. Access to community care for people with dementia and their informal carers. Z Gerontol Geriat 51, 530–536 (2018). https://doi.org/10.1007/s00391-017-1266-7
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DOI: https://doi.org/10.1007/s00391-017-1266-7