Care Integration in Primary Dementia Care Networks: A Longitudinal Mixed-Methods Study

Abstract

Introduction: Currently, care integration for community-dwelling persons with dementia is poor and knowledge on how to effectively facilitate development of integrated dementia care is lacking. The DementiaNet program aims to overcome this with a focus on interprofessional collaboration. The objective of this study is to investigate how care integration in interprofessional primary dementia care networks matures and to identify factors associated with (un)successfully maturation.

Theory and methods: A longitudinal mixed-methods study, including 17 primary care networks participating in the DementiaNet study, was performed. Semi-structured interviews based on the Rainbow Model of Integrated Care were conducted at start, at 12- and 24 months. Network maturity scores (range 1-4) were derived from the interviews and qualitative data was used to explain the observed patterns.

Results: Networks consisted on average of 9 professionals (range 4-22) covering medical, care and social disciplines. Network maturity yearly increased with 0.29 (95%-CI: 0.20-0.38). Important factors for improvement included getting to know each other's expertise, having a capable network leader(s), stable network composition and participation of a general practitioner.

Conclusions: The DementiaNet approach enables a transition towards more mature networks. Identified success factors provide better understanding of how network maturity can be achieved and gives guidance to future care integration strategies.

Keywords: dementia care; integrated care; interprofessional collaboration; network-based care; primary care.

Figure 1

Key elements of the DementiaNet program.

Figure 2

Rainbow Model of Integrated Care. Adapted with permission from Essenburgh Research & Consultancy [22].

Figure 3

Network maturity trajectories of all networks with Network Maturity Scores on a scale of 1–4. Dashed lines represent networks with an existing collaboration, solid lines represent new networks and the bold line is the mean.

Figure 4

Patterns of the network maturity score trajectories over time for the networks. A.) Trajectories of networks where network maturity improved; B.) Trajectories of networks that maintained their high network maturity; and C.) Trajectories of networks where network maturity was not improved or sustained.