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Open referral policy within a nurse-led memory clinic: patient demographics, assessment scores, and diagnostic profiles

Published online by Cambridge University Press:  08 December 2014

Melinda Minstrell ,
Michael Bentley Open the ORCID record for Michael Bentley [Opens in a new window] ,
Hazel Bucher ,
Martin Morrissey ,
Carl Higgs ,
Andrew Robinson  and
Christine Stirling
Melinda Minstrell
Affiliation:
Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania 7001, Australia
Michael Bentley
Affiliation:
Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania 7001, Australia
Hazel Bucher
Affiliation:
Department of Health and Human Services, Tasmania Older Persons Mental Health, 90 Davey Street, Hobart, Tasmania 7000, Australia
Martin Morrissey
Affiliation:
Department of Health and Human Services, Tasmania Older Persons Mental Health, 90 Davey Street, Hobart, Tasmania 7000, Australia
Carl Higgs
Affiliation:
Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania 7001, Australia
Andrew Robinson
Affiliation:
Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania 7001, Australia School of Health Sciences, University of Tasmania, Hobart, Tasmania 7000, Australia
Christine Stirling*
Affiliation:
School of Health Sciences, University of Tasmania, Hobart, Tasmania 7000, Australia
*
Correspondence should be addressed to: Christine Stirling, Associate Professor, School of Health Sciences, University of Tasmania, Private Bag 135, Hobart, TAS 7000, Australia. Phone: +61-3-6226-4678; Fax: +61-3-6226-4690. Email: Christine.Stirling@utas.edu.au.
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Abstract

Background:

Memory clinics, typically led by multidisciplinary teams and requiring health professional referral, are one means of providing diagnosis and care coordination for dementia. Nurse-led clinics may provide an effective and alternative means to dementia diagnosis, and open referral policies may minimize existing barriers to accessing a diagnosis, but evidence is needed.

Methods:

Patients attending a one-day per week nurse-led memory clinic over a 25-month period during 2011–2013 (n = 106) completed comprehensive cognitive assessments and were diagnosed by an aged care nurse practitioner. Descriptive statistics detail the demographics, assessment scores, and diagnostic profiles of patients. Comparable data from published literature was identified, and the differences were analyzed qualitatively.

Results:

One hundred and six patients were assessed with the key differences from other data sets being history of falls more common, higher mean Mini-Mental State Examination scores, and fewer dementia diagnoses. Sixty-four patients (60%) were self-referred to the nurse-led memory clinic, of which 19 (30%) were diagnosed with mild cognitive impairment (MCI) or dementia. Overall, forty-eight patients (45%) received diagnoses of MCI or dementia.

Conclusions:

An open referral policy led to a high proportion of patients being self-referred, and nearly a third of these were diagnosed with cognitive impairment or dementia. Open referral policies and nurse-led services may overcome some of the barriers to early diagnosis that are currently experienced. Considering an aging population worldwide and the associated increases in cognitive impairment, which benefits from early identification and intervention, this paper provides an alternative model of nurse-led assessment.

Keywords

memory clinicnurse practitioneropen referral policynurse-led clinicself-referraldementia
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 6 , June 2015 , pp. 967 - 979
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Adler, N. E. and Newman, K. (2002). Socio-economic disparities in health: pathways and policies. Health Affairs, 21, 60–76.Google Scholar
Banerjee, S., Willis, R., Matthews, D., Contell, F., Chan, J. and Murray, J. (2007). Improving the quality of care for mild to moderate dementia: an evaluation of the Croydon Memory Service Model. International Journal of Geriatric Psychiatry, 22, 782–788.CrossRefGoogle ScholarPubMed
Barker, A., Carter, C. and Jones, R. (1994). Memory performance, self-reported memory loss and depressive symptoms in attenders at a GP-referral and a self-referral memory clinic. International Journal of Geriatric Psychiatry, 9, 305–311.CrossRefGoogle Scholar
Bentley, M., Minstrell, M., Bucher, H., Morrissey, M., Robinson, A. and Stirling, C. (2014). A case study evaluation protocol to assess processes, effectiveness and impact of a nurse practitioner-led memory clinic. Health, 6, 748–756.Google Scholar
Boman, E. K. O. and Walker, G. A. (2010). Predictors of men's health care utilization. Psychology of Men & Masculinity, 11, 113–122.Google Scholar
Burns, A. and Iliffe, S. (2009). Dementia. British Medical Journal, 338, 467–471.CrossRefGoogle Scholar
Dennis, M., Furness, L., Lindesay, J. and Wright, N. (1998). Assessment of patients with memory problems using a nurse-administered instrument to detect early dementia and dementia subtypes. International Journal of Geriatric Psychiatry, 13, 405–409.Google Scholar
Drašković, I., Vernooij-Dassen, M., Verhey, F., Scheltens, P. and Rikkert, M. O. (2008). Development of quality indicators for memory clinics. International Journal of Geriatric Psychiatry, 23, 119–128.CrossRefGoogle ScholarPubMed
Dubois, B., Slachevsky, A., Litvan, I. and Pillon, B. (2000). The FAB: a frontal assessment battery at bedside. Neurology, 55, 1621–1626.Google Scholar
Ellis, K. A. et al. (2009). The Australian Imaging, Biomarkers and Lifestyle (AIBL) study of aging: methodology and baseline characteristics of 1112 individuals recruited for a longitudinal study of Alzheimer's disease. International Psychogeriatrics, 21, 672–687.Google Scholar
Gardner, G., Carryer, J., Dunn, S. and Gardner, A. (2004). Nurse Practitioner Standards Project. Report to Australian Nursing and Midwifery Council, Position Statement on Advanced Nursing Practice. Brisbane, Australia: Royal College of Nursing (RCNA).Google Scholar
Getsios, D. (2012). An economic evaluation of early assessment for Alzheimer's disease in the United Kingdom. Alzheimer's & Dementia, 8, 22–30.Google Scholar
Gladman, J. R. F., Jones, R. G., Radford, K., Walker, E. and Rothera, I. (2007). Person-centred dementia services are feasible, but can they be sustained? Age and Ageing, 36, 171–176.CrossRefGoogle ScholarPubMed
Gonҫalves, D., Arnold, E., Appadurai, K. and Byrne, G. J. (2011). Case finding in dementia: comparative utility of three brief instrumentss in the memory clinic setting. International Psychogeriatrics, 23, 788–796.Google Scholar
Hansen, E., Robinson, A., Mudge, P. and Crack, G. (2005). Barriers to the provision of care for people with dementia and their carers in a rural community. Australian Journal of Primary Health, 11, 72–79.Google Scholar
Hatchett, R. (2008). Nurse-led clinics: 10 essential steps to setting up a service. Nursing Times, 104, 62–64.Google Scholar
Jolley, D., Benbow, S. M. and Grizzell, M. (2006). Memory clinics. Postgraduate Medical Journal, 82, 199–206.CrossRefGoogle ScholarPubMed
Jorm, A. F. (1994). A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychological Medicine, 24, 145–153.CrossRefGoogle Scholar
Kaufer, D. I. et al. (2000). Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. Journal of Neuropsychiatry and Clinical Neurosciences, 12, 233–239.Google Scholar
Kertesz, A., Davidson, W. and Fox, H. (1997). Frontal behavioral inventory: diagnostic criteria for frontal lobe dementia. Canadian Journal of Neurological Sciences, 24, 29–36.Google Scholar
Millard, F. B., Kennedy, R. L. and Baune, B. T. (2011). Dementia: opportunities for risk reduction and early detection in general practice. Australian Journal of Primary Health, 17, 89–94.Google Scholar
Mioshi, E., Dawson, K., Mitchell, J., Arnold, R. and Hodges, J. R. (2006). The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. International Journal of Geriatric Psychiatry, 21, 1078–1085.Google Scholar
Mitchell, A. J., Meader, N. and Pentzek, M. (2011). Clinical recognition of dementia and cognitive impairment in primary care: a meta-analysis of physician accuracy. Acta Psychiatrica Scandinavica, 124, 165–183.CrossRefGoogle ScholarPubMed
Mullins, J. and Fitch, F. (2000). Diagnosis by request: a self-referral memory clinic. Journal of Dementia Care, 8, 30–31.Google Scholar
Page, S., Hope, K., Bee, P. and Burns, A. (2008). Nurses making a diagnosis of dementia – a potential change in practice? International Journal of Geriatric Psychiatry, 23, 27–33.Google Scholar
Prince, M. (2008). The Prevalence of Dementia Worldwide. Alzheimer's Disease International Factsheet. London: Alzheimer's Disease International.Google Scholar
Prince, P. M., Bryce, D. R. and Ferri, D. C. (2011). World Alzheimer Report 2011: The Benefits of Early Diagnosis and Intervention. London: Institute of Psychiatry, King's College.Google Scholar
Robinson, A., Elder, J., Emden, C., Lea, E., Turner, P. and Vickers, J. (2009). Information pathways into dementia care services. Dementia, 8, 17–37.Google Scholar
Scott, D. and Donnelly, M. (2005). The early identification of cognitive impairment. Dementia, 4, 207–232.Google Scholar
Seymour, J., Saunders, P., Wattis, J. P. and Daly, L. (1994). Evaluation of early dementia by a trained nurse. International Journal of Geriatric Psychiatry, 9, 37–42.Google Scholar
Sona, A. et al. (2012). Predictors of rapid cognitive decline in Alzheimer's disease: results from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study of ageing. International Psychogeriatrics, 24, 197–204.CrossRefGoogle ScholarPubMed
Stirling, C., Campbell, B., Bentley, M., Bucher, H. and Morrissey, M. (2013). A qualitative study of patients’ experiences of a nurse-led memory clinic. Dementia. Epublished ahead of print, doi: 10.1177/1471301213512841 Google Scholar
Stratford, J. A., LoGiudice, D., Flicker, L., Cook, R., Waltrowicz, W. and Ames, D. (2003). A memory clinic at a geriatric hospital: a report of 577 patients assessed with the CAMDEX over 9 years. Australian & New Zealand Journal of Psychiatry, 37, 319–326.CrossRefGoogle Scholar
Sudore, R. L. et al. (2006). Limited literacy in older people and disparities in health and healthcare access. Journal of the American Geriatrics Society, 54, 770–776.Google Scholar
Terpening, Z., Cordato, N. J., Hepner, I. J., Lucas, S. K. and Lindley, R. I. (2011). Utility of the Addenbrooke's Cognitive Examination – Revised for the diagnosis of dementia syndromes. Australasian Journal on Ageing, 30, 113–118.Google Scholar
Turner, S. et al. (2004). General practitioners’ knowledge, confidence and attitudes in the diagnosis and management of dementia. Age and Ageing, 33, 461–467.CrossRefGoogle ScholarPubMed
van den Dungen, P. et al. (2012). The accuracy of family physicians’ dementia diagnoses at different stages of dementia: a systematic review. International Journal of Geriatric Psychiatry, 27, 342–354.CrossRefGoogle ScholarPubMed
Williams, A. and Jones, M. (2006). Patients’ assessments of consulting a nurse practitioner: the time factor. Journal of Advanced Nursing, 53, 188–195.CrossRefGoogle ScholarPubMed
Woodward, M. C. and Woodward, E. (2009). A national survey of memory clinics in Australia. International Psychogeriatrics, 21, 696–702.Google Scholar
Yesavage, J. A. and Sheikh, J. I. (1986). Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist, 5, 165–173.Google Scholar