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Joining the dots: Day to day challenges for practitioners in delivering integrated dementia care
Author(s) -
Chase Mike,
Lloyd Christopher E.M.,
Peters Benjamin J.,
Chase Elaine,
Lee Kellyn
Publication year - 2021
Publication title -
health and social care in the community
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.984
H-Index - 68
eISSN - 1365-2524
pISSN - 0966-0410
DOI - 10.1111/hsc.13140
Subject(s) - project commissioning , dementia , attendance , focus group , multidisciplinary approach , service provider , unintended consequences , integrated care , nursing , resource (disambiguation) , public relations , service (business) , medicine , psychology , sociology , publishing , health care , business , political science , computer science , computer network , social science , disease , pathology , marketing , anthropology , law
Despite the increasing policy focus on integrated dementia care in the UK, little is known about the opportunities and challenges encountered by practitioners charged with implementing these policies on the ground. We undertook an extensive, mixed‐methods analysis of how a contemporary multidisciplinary dementia pathway in the UK was experienced and negotiated by service providers. Our pragmatic mixed methods design incorporated three types of research interaction with practitioners: (a) Semi‐structured interviews ( n = 31) and focus group discussions ( n = 4), (b) Practitioner ‘shadowing’ observations ( n = 19), and (c) Service attendance and performance metrics reviews ( n = 8). Through an abductive analysis of practitioner narratives and practice observations, we evidenced how inter‐practitioner prejudices, restrictive and competitive commissioning frameworks, barriers to effective data sharing and other resource constraints, all challenged integrative dementia care and led to unintended consequences such as practice overlap and failure to identify and respond to people's needs. In order to more successfully realise integrated dementia pathways, we propose innovative commissioning frameworks which purposefully seek to diffuse power imbalances, encourage inter‐provider respect and understanding, and determine clear lines of responsibility.