Conectar
Providing care management, treatment and support to patients with Alzheimer’s Disease and Related Dementias (ADRD) is a difficult task for health systems. Over the past 20 years, interventions designed to improve outcomes for patients living in the community with dementia and their care partners have moved progressively, but separately, from large scale trials and pragmatic models of collaborative care. Given the projected increase in the number of people living with dementia coupled with the realignment of payment for services to be value-based and provided in the community, system-level approaches are needed to address the complex needs of patients with a dementia diagnosis and their care partners. We designed a statewide, pragmatic trial to evaluate virtual delivery of an evidence-based dementia collaborative care program on patient healthcare utilization and medication use.
The Aging Brain Care Virtual (ABCV) program is a 12-month embedded, cluster randomized, usual care controlled trial designed to test the effectiveness of a virtual dementia collaborative care program in 24 Indiana University Health primary care clinics (12 intervention, 12 control) across the state of Indiana, enrolling 860 persons living with dementia (430 intervention, 430 control) and their care partners. ABCV relies on a tailored approach in which dyad needs are identified during virtual visits and addressed with standardized protocols previously tested in a randomized controlled trial delivered in person. The ABCV trial will measure emergency department utilization (primary outcome) and appropriate medication use (secondary outcome) at 12 months using electronic medical record data. Additionally, this study will use semi-structured interviews with care partners and clinicians to explore the implementation context, process and outcomes of the ABCV program.
Ethics approval was obtained from the Indiana University Institutional Review Board (20249). Research findings will be published in peer-reviewed journals and presented at scientific conferences.
To explore the barriers, facilitators, and outcomes of strategies that have been implemented to improve the experience of cultural safety for First Nations inpatients in the Australian hospital setting.
Scoping review.
Guided by the Joanna Briggs Institute scoping review methodology and reported using PRISMA-ScR, six databases were searched with data extracted and synthesised.
Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emcare, Informit, Medline, ProQuest and Scopus databases. Searches were undertaken in March 2024.
Forty-three articles representing 39 studies were included. Strategies were categorised as governance, service delivery, hospital environment, clinician education, and First Nations workforce. First Nations researchers were co-authors in most studies, and emergent themes were grounded in First Nations priorities, with an emphasis on developing the First Nations health workforce. Findings included (i) First Nations health staff being identified as cultural brokers between First Nations patients and non-First Nations clinicians; (ii) experiences of cultural safety being amplified when First Nations and non-First Nations health staff worked together; and (iii) strong governance being critical to addressing institutional racism and enabling cultural safety.
Embedding the voice of First Nations peoples in governance and an organisational commitment to strengthening the First Nations workforce are essential drivers for implementing cultural safety strategies in Australian hospitals.
Working together respectfully and collaboratively offers a pathway forward for First Nations and non-First Nations health service clinicians and management to deliver culturally safe hospital care.
Culturally safe hospital care is integral to promoting the health of First Nations people. This study maps cultural safety strategies used in the Australian inpatient hospital setting, explores if and how these strategies have improved cultural safety and identifies barriers and facilitators to implementation. Fostering approaches to support understanding and respect between First Nations and non-First Nations clinicians and staff is integral to promoting culturally safe hospital care. Hospital leadership, policymakers and staff can benefit from understanding the drivers of culturally safe hospital care.
Reported using PRISMA-ScR.
Guidance on this research was received from Aboriginal leaders at the first author's hospital workplace.
A research protocol was prepared in advance and registered: https://osf.io/sfzby/?view_only=03c2349ebdae4a7ba95a621d9b7e8bc4.
FreshRSS 