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Table 7 Mixed Method studies. Characteristics of Mixed Methods studies reviewed

From: What is the role of the practice nurse in the care of people living with dementia, or cognitive impairment, and their support person(s)?: a systematic review

Author, year, country Aim Research design Instruments Sample and size (+characteristics) Type and description of intervention Analysis method Outcomes
Ollerernshaw et al, 2017 [32]
Australia
To explore the awareness and usage of an online Dementia Pathways Tool (DPT) for primary health care practitioners in regional Victoria Descriptive On-line questionnaire
Google Analytics provides information on the usage of on-line tools.
A total of 21 GPs and 21 PNs participated in the study. All the GPs and PNs worked in practices located in regional western Victoria.   Descriptive analysis Of the respondents two thirds were aware of the DPT, with one third having used it. Of those who had used it the majority (92.9%) found it useful in assisting them in accessing diagnosis, management and referral information.
Over an 18 month time period from the launch of the DPT, Google Analytics showed an average of 509 views of the DPT webpage a month with an average of 2.03 minutes spent on the site.
Millard et al., 2011 [3]
Australia
Supplementary paper
Millard & Baune, 2009 [33]
To explore dementia literacy in a general practice setting and to test whether a waiting room pamphlet would improve patient awareness of dementia risk reduction Mixed method study: questionnaire, RCT and data from computerised medical records Questionnaire for GP/ PN
Questionnaire for waiting room patients
Computerised medical records.
558 patients(36% male
64% female; median age 50-59 years) were sampled from 22 practices in 14 locations in Australia
63 patients (43% male; 57% female; median age of 70-79 years) were sampled from 3 practices in England.
106 GPs (57 males; 49 female) were recruited from 50 different sites in Australia and 21 GPs (9 male; 12 female) were in England.
26 PNs were recruited to the study in total. All were female and 25 were located in practices in Australia and 1 in England.
Alzheimer’s Australia ‘Mind your Mind” dementia risk reduction pamphlet on patient knowledge of dementia risk strategies
Patients, aged over 30 years, in the waiting room were administered a questionnaire exploring dementia and risk reduction knowledge. The intervention, a risk reduction education pamphlet, were administered to the patients using a
simple randomisation with 50% of the participants receiving the pamphlet with questionnaire and
50% receiving the questionnaire only.
SPSS
Bivariate analysis
Pearson’s Chi-squared test
Odds ratio
There were no significant differences in dementia literacy between age groups, country or gender. Sources of dementia knowledge included ‘media’ (32.5%), ‘acquaintances’ (30.6%), and ‘workplace’ (15.9%) with a minority answering ‘doctor’ (1.3%). Despite the majority of respondents having not heard about dementia from their doctor, 81% would seek help from a doctor if thought they had dementia.
One third of GPs and two thirds of PNs reported lacking dementia training. Just under one quarter of GPs and under one fifth of PNs considered their dementia knowledge adequate. There was no significant relationship between training and adequacy of dementia knowledge. Despite this lack of self-reported lack of dementia knowledge, two thirds of doctors and three quarters of PNs responded that a doctor or nurse was the appropriate person to discuss dementia with patients.
Perry et al., 2010 [34]
Netherlands
To construct a set of quality indicators (QIs) for dementia diagnosis and management in a primary care setting. Mixed methods RAND modified Delphi including a postal survey, stakeholders consensus meeting, a scientific expert consensus meeting and demonstration project Postal survey
GPs and PCNs assessed relevance, feasibility of QIs
Informal support person(s) assessed relevance of QI only
Inclusion, exclusion, revision of QIs by consensus at stakeholder and scientific expert meetings
Demonstration project tested adherence rates and discriminative validity.
GPs (67), PCNs (21) and informal care-givers (34).
Eight national dementia experts (1 geriatrician, 2 GPs, 2 nursing scientists, 1 medical sociologist, 1 psychologist, 2 geriatric nurses) in expert panel and scientific consensus meeting.
1 GP, 2 PCNs and 4 informal support person(s) in stakeholders consensus meeting
Thirteen GPs in the demonstration project.
GPs and PCNs were recruited at continuing medical education meetings.
Informal support person(s) were recruited at the memory clinic of the Radboud University Nijmegen Medical Centre.
  Cronbach alpha
Intraclass correlation
Mean scores and standard deviations
ANOVA
The final set of 23 QIs included 15 QIs containing innovative quality criteria on collaboration between GPs and PCNs, referral criteria and assessment of support person(s) needs. Several indicators explicitly describe collaboration between GPs and PCNs, an area in which improvement is highly recommended.
The QIs are reported as feasible, reliable and valid able to be used to improve primary dementia care.
Iliffe et al., 2014 [35]
United Kingdom
Supplementary papers
Bamford et al., 2014 [36]
Iliffe et al., 2014 [37]
Waugh et al., 2013 [38]
To adapt a US model of primary care-based case management (CM) (PREVENT) for people with dementia and test it in General Practice Mixed methodology comprising case studies of CM implementation in four General Practices
and Interview with patients, support person(s), local NHS and other stakeholders, and case managers
CAREDEM Case management Participants were community dwelling patients with dementia who were living at home with a family support person(s) and who were not receiving specialist care coordination.
A total of 28 dyads and 1 support person(s) were recruited across four practices; one rural, one inner-city and two urban.
The CAREDEM intervention consisted of CM face to face training and mentoring based on an educational needs assessment, development of a learning manual that could be shared between CMs and patient-support person(s) dyads and identification of skills needed by dementia CMs working in primary care. Thematic analysis of data was synthesised in an iterative process until consensus was reached This study suggested that CM does not fit easily into practice routines and that it was not substantially beneficial for patients and support person(s) despite CMs, patients and support person(s) reporting a positive experience of CM.
Perceived benefits of CM by the dyad included having a first point-of-contact, a ‘safety net’ and the creation of a one-to-one therapeutic relationship.
CM perceived advantages was provision of continuity of care and flexibility of responsiveness to needs.
The NHS and social care professionals perceived advantages of CM as continuity of care, earlier intervention and that it was complementary to existing secondary care and social services.
All case managers cited time constraints as an obstacle to working with their target group and identified relatively few concrete benefits to participating patients and support person(s).