General Practice and Primary Care - Theses
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ItemSupporting primary care practitioners to promote dementia risk reduction in Australian general practice: development and pilot evaluation of a practice change intervention and targeted implementation approach( 2023-10)Background. People in Australia have limited awareness of the potential for dementia risk reduction. General practice is an appropriate setting for promoting dementia risk reduction, yet it is not routinely discussed. The objectives of the Preventing Cognitive Impairment in Practice Project were to (1) develop an intervention for promoting dementia risk reduction in Australian general practice, (2) assess barriers to implementing the intervention, (3) develop an implementation approach in which strategies to mitigate assessed barriers were selected, operationalised, and introduced progressively, and (4) pilot the intervention and implementation approach in Australian general practices. Methods. The project was guided by a range of frameworks (eg, the Knowledge-to-Action Framework, the Consolidated Framework for Implementation Research). The project comprised six separate studies, including two scoping reviews, qualitative interviews with Australian primary care practitioners, retrospective analysis of discussion board posts from non-medically trained enrollees in a free online educational course about dementia risk reduction, development of an intervention and targeted implementation approach based on evidence and stakeholder consultation, and a pilot evaluation of implementation outcomes in five general practices in Melbourne, Australia. Results. The intervention comprised a patient survey to be completed in the waiting room and patient information cards to be used during consultations, both of which were designed to prompt specific practitioner actions. The implementation approach combined educational materials, outreach visits, local consensus discussions about whether dementia risk reduction was important and whether the proposed practice changes were appropriate, champions to drive implementation within general practices, and capturing and sharing knowledge across general practices. On piloting, implementation outcomes were mixed. Both the intervention and implementation approach were broadly acceptable and feasible, but penetration (‘reach’) was low. Discussion. The Preventing Cognitive Impairment in Practice Project led to an acceptable and feasible practice change intervention and targeted implementation approach that can support the promotion of dementia risk reduction in Australian general practices. Interpretation of the evaluation data identified opportunities for refinements to the intervention and implementation approach. Female participants and self-selected participants interested in DRR were overrepresented throughout the project. Future research could examine hypotheses about implementation outcomes arising from the pilot study, consider additional implementation outcomes, and adapt the intervention and targeted implementation approach for other contexts and populations.