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dc.contributor.authorFrost, R
dc.contributor.authorWalters, K
dc.contributor.authorAw, S
dc.contributor.authorBrunskill, G
dc.contributor.authorWilcock, J
dc.contributor.authorRobinson, L
dc.contributor.authorKnapp, M
dc.contributor.authorHarrison-Dening, K
dc.contributor.authorAllan, L
dc.contributor.authorManthorpe, J
dc.contributor.authorRait, G
dc.date.accessioned2019-09-18T14:51:14Z
dc.date.issued2019
dc.description.abstractBackground: The World Alzheimer Report 2016 proposed a task-shifted model of post-diagnostic dementia care, moving towards primary and community-based care. It is unclear how this may best be delivered. Aim: To assess the effectiveness and cost-effectiveness of primary care-based models of post-diagnostic dementia care. Design and setting: Systematic review of trials and economic evaluations of post-diagnostic dementia care interventions where primary care was substantially involved in care plan decision making. Method: Searches of MEDLINE, PsychINFO, EMBASE, Web of Science and CINAHL (inception-March 2019). Two authors independently critically appraised studies and inductively classified interventions into types of care models. Random effects meta-analysis or narrative synthesis was conducted for each model where appropriate. Results: From 4506 unique references and 357 full texts, we included 23 papers from 10 trials of nine interventions, delivered in four countries. We identified four types of care models. Primary care provider (PCP)-led care (n=1) led to better caregiver mental health and reduced hospital and memory clinic costs compared to memory clinics. PCP-led care with specialist consulting support (n=2) did not have additional effects on clinical outcomes or costs over usual primary care. PCP-case management partnership models (n=6) offered the most promise, with impact on neuropsychiatric symptoms, caregiver burden, distress and mastery and healthcare costs. Integrated primary care memory clinics (n=1) had limited evidence for improved quality of life and cost-effectiveness compared to memory clinics. Conclusion: Partnership models may impact on some clinical outcomes and healthcare costs. More rigorous evaluation of promising primary care-led care models is needed.en_GB
dc.description.sponsorshipAlzheimer’s Societyen_GB
dc.description.sponsorshipNIHRen_GB
dc.identifier.citationAwaiting citation and DOIen_GB
dc.identifier.grantnumber331en_GB
dc.identifier.grantnumberNF-SI-0616-10054.en_GB
dc.identifier.urihttp://hdl.handle.net/10871/38810
dc.language.isoenen_GB
dc.publisherRoyal College of General Practitionersen_GB
dc.rights.embargoreasonUnder temporary indefinite embargo pending publication by Royal College of General Practitioners. 12 month embargo to be applied on publicationen_GB
dc.subjectdementiaen_GB
dc.subjectprimary health careen_GB
dc.subjectsystematic reviewen_GB
dc.titleHow effective are models of post-diagnostic dementia care delivered by primary care? A systematic reviewen_GB
dc.typeArticleen_GB
dc.date.available2019-09-18T14:51:14Z
dc.identifier.issn0960-1643
dc.descriptionThis is the author accepted manuscripten_GB
dc.identifier.journalBritish Journal of General Practiceen_GB
dc.rights.urihttp://www.rioxx.net/licenses/all-rights-reserveden_GB
dcterms.dateAccepted2019-09-17
rioxxterms.versionAMen_GB
rioxxterms.licenseref.startdate2019-09-17
rioxxterms.typeJournal Article/Reviewen_GB
refterms.dateFCD2019-09-18T13:50:31Z
refterms.versionFCDAM
refterms.panelAen_GB


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