Health  Vol.6 No.8 , March 2014
A Case Study Evaluation Protocol to Assess Processes, Effectiveness and Impact of a Nurse Practitioner-Led Memory Clinic
Abstract: The prevalence of dementia is predicted to increase significantly as the population ages and with no foreseeable cure options the burden of dementia will continue to grow. Early diagnosis provides many benefits, including timely access to appropriate support services and provision of tailored therapeutic interventions for people with dementia and their carers. Memory clinics are a key response to the need for specialist assessment and diagnosis of dementia. Multidisciplinary team memory clinics are considered the “gold standard”; however, such resource intensive clinics are likely unsustainable. The nurse-led memory clinic format may provide a primary care focused, diagnostic service for dementia that does not have the cost implications of multidisciplinary memory clinics but there is limited research using nurse practitioners. This study is exploring the potential of a nurse-led memory clinic as a primary health care approach to health promotion (brain health awareness), disease prevention (risk factor reduction) and early intervention (diagnosis and management of dementia). A realistic evaluation of a nurse practitioner-led memory clinic is described. Realistic evaluation is concerned not only with the outcomes of an intervention but also with the context and mechanisms of the intervention. We are using a mixed methods case study design to describe and evaluate the impact of the nurse practitioner-led memory clinic. The nurse practitioner in this study is an advanced practice aged care nurse who focuses on mental health, and dementia diagnosis, management and risk factor reduction. This study seeks to inform the development of an expanded scope role for nurse practitioners in assessment and referrals for dementia diagnosis. The heterogeneity of clients attending the nurse-led memory clinic will allow us to evaluate what works in the memory clinic, for whom, and under what circumstances, in what respects, and to what extent.
Cite this paper: 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. doi: 10.4236/health.2014.68096.

[1]   Jorm, A.F., Dear, K.B. and Burgess, N.M. (2005) Projections of Future Numbers of Dementia Cases in Australia with and without Prevention. Australian and New Zealand Journal of Psychiatry, 39, 959-963.

[2]   Access Economics (2009) Keeping Dementia Front of Mind: Incidence and Prevalence 2009-2050.

[3]   Nepal, B., Ranmuthugala, G., Brown, L. and Budge, M. (2008) Modelling Costs of Dementia in Australia: Evidence, Gaps, and Needs. Australian Health Review, 32, 479-487.

[4]   Prince, M.J., Bryce, D.R. and Ferri, C.P. (2011) The Benefits of Early Diagnosis and Intervention.

[5]   Burns, A. and Iliffe, S. (2009) Alzheimer’s Disease. British Medical Journal, 338, b158.

[6]   Getsios, D. (2012) An Economic Evaluation of Early Assessment for Alzheimer’s Disease in the United Kingdom. Alzheimer’s & Dementia, 8, 22-30.

[7]   Labonté, R., Pooyak, S., Baum, F., Schaay, N., Packer, C., Laplante, D., et al. (2008) Implementation, Effectiveness and Political Context of Comprehensive Primary Health Care: Preliminary Findings of a Global Literature Review. Australian Journal of Primary Health, 14, 58-67.

[8]   Bradford, A., Kunik, M., Schulz, P., Williams, S. and Singh, H. (2009) Missed and Delayed Diagnosis of Dementia in Primary Care: Prevalence and Contributing Factors. Alzheimer Disease & Associated Disorders, 23, 306-314.

[9]   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.

[10]   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.

[11]   Hansen, E.C., Hughes, C., Routley, G. and Robinson, A.L. (2008) General Practitioners’ Experiences and Understandings of Diagnosing Dementia: Factors Impacting on Early Diagnosis. Social Science & Medicine, 67, 1776-1783.

[12]   Wiese, M., Jolley, G., Baum, F., Freeman, T. and Kidd, M. (2011) Australia’s Systems of Primary Healthcare—The Need for Improved Coordination and Implications for Medicare Locals. Australian Family Physician, 40, 995-999.;dn=686937046799945;res=IELHEA

[13]   Bond, J., Stave, C., Sganga, A., O’Connell, B. and Stanley, R.L. (2005) Inequalities in Dementia Care across Europe: Key Findings of the Facing Dementia Survey. International Journal of Clinical Practice, Supp. 59, 8-14.

[14]   Greenway-Crombie, A., Snow, P., Disler, P., Davis, S. and Pond, D. (2012) Influence of Rurality on Diagnosing Dementia in Australian General Practice. Australian Journal of Primary Health, 18, 178-184.

[15]   Ganguli, M., Rodriguez, E., Muslant, B., Richards, S., Pandav, R., Vander Bilt, J., et al. (2004) Detection and Management of Cognitive Impairment in Primary Care: The Steel Valley Seniors Survey. Journal of the American Geriatrics Society, 52, 1668-1675.

[16]   Valcour, V.G., Masaki, K.H., Curb, J.D. and Blanchette, P.L. (2000) The Detection of Dementia in the Primary Care Setting. Archives of Internal Medicine, 160, 2964-2968.

[17]   Brodaty, H. (2007) Early Diagnosis of Dementia.

[18]   Turner, S., Iliffe, S., Downs, M., Wilcock, J., Bryans, M., Levin, E., Keady, J. and O’Carroll, R. (2004) General Practitioners’ Knowledge, Confidence and Attitudes in the Diagnosis and Management of Dementia. Age and Ageing, 33, 461-467.

[19]   Christian, D. (2009) Nurse-Led Memory Clinics Set to Improve Dementia Care in England. Nursing Older People, 21, 5.

[20]   Szymczynska, P., Innes, A., Mason, A. and Stark, C. (2011) A Review of Diagnostic Process and Postdiagnostic Support for People with Dementia in Rural Areas. Journal of Primary Care & Community Health, 2, 262-276.

[21]   Lee, L., Hillier, L., Stolee, P., Heckman, G., Gagnon, M., McAiney. C. and Harvey, D. (2010) Enhancing Dementia Care: A Primary Care-Based Memory Clinic. Journal of the American Geriatrics Society, 58, 2197-2204.

[22]   Woodward, M.C. and Woodward, E. (2009) A National Survey of Memory Clinics in Australia. International Psychogeriatrics, 21, 696-702.

[23]   Jolley, D., Benbow, S.M. and Grizzell, M. (2006) Memory Clinics. Postgraduate Medical Journal, 82, 199-206.

[24]   Phipps, A.J. and O’Brien, J.T. (2002) Memory Clinics and Clinical Governance—A UK Perspective. International Journal of Geriatric Psychiatry, 17, 1128-1132.

[25]   Wolfs, C.A.G., Dirksen, C.D., Severens, J.L. and Verhey, F.R.J. (2006) The Added Value of a Multidisciplinary Approach in Diagnosing Dementia: A Review. International Journal of Geriatric Psychiatry, 21, 223-232.

[26]   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.

[27]   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.

[28]   Hain, D., Dunn, D. and Tappen, R. (2011) Patient-Provider Partnership in a Memory Disorder Center. Journal of the American Academy of Nurse Practitioners, 23, 351-356.

[29]   Gonçalves, D., Arnold, E., Appadurai, K. and Byrne, G.J. (2011) Case Finding in Dementia: Comparative Utility of Three Brief Instruments in the Memory Clinic Setting. International Psychogeriatrics, 23, 788-796.

[30]   Arbon, P., Bail, K., Eggert, M., Gardner, A., Hogan, S., Phillips, C., et al. (2009) Reporting a Research Project on the Potential of Aged Care Nurse Practitioners in the Australian Capital Territory. Journal of Clinical Nursing, 18, 255-262.

[31]   Driscoll, A., Worrall-Carter, L., O’Reilly, J. and Stewart, S, (2005) A Historical Review of the Nurse Practitioner Role in Australia. Clinical Excellence for Nurse Practitioners, 9, 141-152.

[32]   Australian College of Nurse Practitioners (2014) History.

[33]   Nursing and Midwifery Board of Australia (2013) Statistics.

[34]   Wong, G., Greenhalgh, T., Westhorp, G. and Pawson, R. (2012) Realist Methods in Medical Education Research: What Are They and What Can They Contribute? Medical Education, 46, 89-96.

[35]   Douglas, F.C., Gray, D.A. and van Teijlingen, E.R. (2010) Using a Realist Approach to Evaluate Smoking Cessation Interventions Targeting Pregnant Women and Young People. BMC Health Services Research, 10, 49.

[36]   Pawson, R. and Tilley, N. (1997) Realistic Evaluation. Sage Publications, London.

[37]   Wand, T., White, K. and Patching, J. (2010) Applying a Realist(ic) Framework to the Evaluation of a New Model of Emergency Department Based Mental Health Nursing Practice. Nursing Inquiry, 17, 231-239.

[38]   The Research Institute for the Care of the Elderly (2011-2014) Memory Clinic.

[39]   McKeith, I., Glasako, D., Kosaka, K., Perry, E., Dickson, D., Hansen, L., et al. (1996) Consensus Guidelines for the Clinical and Pathologic Diagnosis of Dementia with Lewy Bodies (DLB): Report of the Consortium on DLB International Workshop. Neurology, 47, 113-124.

[40]   Gardner, G., Carryer, J., Dunn, S. and Gardner, A. (2004) The Nurse Practitioner Standards Project. Australian Nursing and Midwifery Council, Canberra.

[41]   Anthony, S. and Jack, S. (2009) Qualitative Case Study Methodology in Nursing Research: An Integrative Review. Journal of Advanced Nursing, 65, 1171-1181.

[42]   Yin, R.K. (2008) Case Study Research: Design and Methods. 4th Edition, Sage Publications, Thousand Oaks.

[43]   Bergen, A. and While, A. (2000) A Case for Case Studies: Exploring the Use of Case Study Design in Community Nursing Research. Journal of Advanced Nursing, 31, 926-934.

[44]   Caris-Verhallen, W.M.C.M., Kerkstra, A., Bensing, J.M. and Grypdonck, M.H.F. (2000) Effects of Video Interaction Analysis Training on Nurse-Patient Communication in the Care of the Elderly. Patient Education and Counseling, 39, 91-103.

[45]   Cameron, N. and McMillan, R, (2006) Enhancing Communication Skills by Peer Review of Consultation Videos. Education for Primary Care, 17, 40-48.

[46]   Martin-Khan M., Varghese, P., Wootton, R. and Gray, L. (2008) Physical Examination and Diagnosis of Dementia for Video Consultation. Journal of the American Geriatrics Society, 56, 947-949.

[47]   Fine, E., Reid, M.C., Shengelia, R. and Adelman, R.D. (2010) Directly Observed Patient-Physician Discussions in Palliative and End-of-Life Care: A Systematic Review of the Literature. Journal of Palliative Medicine, 13, 595-603.

[48]   Roter, D. and Larson, S. (2002) The Roter Interaction Analysis System (RIAS): Utility and Flexibility for Analysis of Medical Interactions. Patient Education and Counseling, 46, 243-251.

[49]   Salih, S.A., Wootton, R., Beller, E. and Gray, L. (2007) The Validity of Video Clips in the Diagnosis of Gait Disorder. Journal of Telemedicine and Telecare, 13, 333-336.

[50]   Gilbert, D.A. and Hayes, E. (2009) Communication and Outcomes of Visits between Older Patients and Nurse Practitioners. Nursing Research, 58, 283-293.

[51]   Hayes, E. (2006) Promoting Nurse Practitioner Practice through Research: Opportunities, Challenges, and Lessons. Journal of the American Academy of Nurse Practitioners, 18, 180-186.

[52]   Riley, R.G. and Manias, E. (2004) The Uses of Photography in Clinical Nursing Practice and Research: A Literature Review. Journal of Advanced Nursing, 48, 397-405.

[53]   Coleman, T. (2000) Using Video-Recorded Consultations for Research in Primary Care: Advantages and Limitations. Family Practice, 17, 422-427.

[54]   Pearce, C., Arnold, M., Phillips, C. and Dwan, K. (2010) Methodological Considerations of Digital Video Observation: beyond Conversation Analysis. International Journal of Multiple Research Approaches, 4, 90-99.

[55]   Ritchie, J. and Spencer, L. (1993) Qualitative Data Analysis for Applied Policy Research. In: Bryman, A. and Burgess, R., Eds., Analysing Qualitative Data, Routledge, London, 173-194.

[56]   Pope, C., Ziebland, S. and Mays, N. (2000) Qualitative Research in Health Care. BMJ, 320, 114-116.

[57]   Sharp, K. (1998) The Case for Case Studies in Nursing Research: The Problem of Generalization. Journal of Advanced Nursing, 27, 785-789.