Background: A national, systematic diagnosis and care pathway has the potential to alleviate pressing challenges experienced by individuals with dementia, their carers, and healthcare providers. International exemplars were sought to compare/contrast dementia care with current practice in the United States (US). The 2013 New Zealand (NZ) Framework for Dementia Care was explored. The aim was to understand this systematic, primary care-led, home- and community-focused dementia management approach from the perspective of those delivering care. Providers in one US state were similarly studied.
Method: Maximum variation purposive sampling was used in this qualitative descriptive study of 28 participants (18 New Zealand, 10 United States). Semi-structured interviews were used, with recruitment of participants continuing until data saturation was reached. Data were then explored for themes using qualitative content analysis.
Results: National standards in NZ provide a progressive pathway grounded in early primary care diagnosis and adaptable teams that foster caregiver support to decrease their burden. The approach also ensures streamlined access to specialists. This is in contrast to the US, where a reactive rather than proactive approach requires providers to navigate unpredictability as they strive to weave together insufficient, inadequate, inconsistent, and inequitable resources to provide families with foundations for an uncertain future.
Conclusion: Compared to the US where only 2.12% of the Medicare spend is on primary care, NZ has a strong primary care foundation. Exploring total cost care models, some states have the capacity to redesign primary care for dementia management within practice and community settings and should take action.
Palumbo, M., Rambur, B., & McKenna, L. (2020) A national dementia care pathway explored. Alzheimer’s Association International Conference. Virtual, July 27-31, 2020.