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01.12.2016 | Research article | Ausgabe 1/2016 Open Access

BMC Health Services Research 1/2016

Provision of dementia-related services in Canada: a comparative study

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2016
Autoren:
Helen Tam-Tham, Alberto Nettel-Aguirre, James Silvius, William Dalziel, Linda Garcia, Frank Molnar, Neil Drummond
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12913-016-1435-1) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

HTT conducted the data analyses and wrote the first draft of the paper. ANA, JS, WD, LG, FM, and ND conceived of the study and design, supervised the data analysis and interpretation of results, and made critical revisions to the manuscript. All authors read and approved the final manuscript.

Abstract

Background

Dementia is common, particularly among older adults, and is one of the major causes of dependency later in life. We sought to provide an overview and comparison of key services related to dementia care as the disease progresses in three large Canadian healthcare centres.

Methods

We identified family physicians, geriatric specialists, and dementia case managers from three major population centres in Canada with universal healthcare coverage. Using a standardized longitudinal dementia case vignette, participants were interviewed on services they would provide at each stage of the disease. We used principles of content analysis to generate codes and identify themes; appropriate time frames from the vignette fitting the necessary provision of services were derived from the Canadian consensus statement and determined in consultation with clinical experts. Proportions of participants that identified dementia-related care services were analyzed at each time point of the vignette using chi-square tests.

Results

Thirty-four healthcare providers from Calgary (Alberta), Edmonton (Alberta), and Ottawa (Ontario) participated. Review of our data identified seven overarching themes of dementia-related care services. Services provided in the community setting include future planning and related services, educational and social support services, and home care and respite services. Although all providers consistently identified educational and social support services (e.g. the Alzheimer Society) within the appropriate time frame, the provision of other services was variable. The proportion of providers reporting potential access of future planning services was significantly different across the three sites (Calgary, 91.7 %; Edmonton; 58.3 %; and Ottawa, 30.0 %), p = 0.012. Also, the proportion of providers that identified day program services were significantly different across the three sites (Calgary, 100.0 %; Edmonton, 91.7 %; and Ottawa, 60.0 %), p = 0.023 according to a chi-square test.

Conclusions

We found important types of variability in service delivery among different regions in Canada for a typical patient with dementia and their family caregiver. Health systems can be calibrated by aligning services from different settings to appropriate time points in the vignette, which illustrates the dynamic course of service delivery and opportunities for improvement throughout the disease trajectory.
Zusatzmaterial
Additional file 1: Interview Guide. At each time point of the vignette (Table 1), the interviewer asked the following questions. Interviewers were permitted to ask follow-up questions for clarification. 1) What action would you take if the patient was presented to you at this stage with this history? 2) Are there any other resources you would consider at this stage? (DOCX 11 kb)
Literatur
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