References

1. Scottish Government (2013), Scotland's National Dementia Strategy 2013-2016. Edinburgh, Scottish Government.

2. Alzheimer Scotland (2017). Connecting People Connecting Support. Available from: http://www.alzscot.org/ahp

3. McGrath, M. and Passmore, P. (2009) Home-based memory rehabilitation programme for persons with mild dementia. Irish Journal of medical Science. 178 (Suppl 8), S330

4. Duncan, E.A.S. & Murray, J.(2012) The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review. BMC Health Services Research201212:96 DOI: 10.1186/1472-6963-12-96

5. Chambers, W. and Groat, A. (2015) Home Based memory rehabilitation programme: an OT early intervention for dementia. British Journal of Occupational Therapy, 78(8 suppl), 20-21

Living well with dementia: connecting people to occupational therapy and Home Based Memory Rehabilitation

Wendy Chambers (NHS Dumfries and Galloway); Alison McKean (Alzheimer Scotland); Lynda Forrest (NHS Dumfries and Galloway); Elaine Hunter (Alzheimer Scotland);Duncan Pentland (Queen Margaret University Edinburgh)

Results

Improving access

Since 2015 when NHS D&G was the only provider, occupational therapy services from another 11 areas have begun offering HBMR (Fig 1). The current test cycle aims to deliver HBMR to 72 people living with dementia (6

from each board area) before review in summer 2017.

Successfully adoption in these areas will mean HBMR is available in the regional boards responsible for providing services to approximately 94% of people who could benefit (Fig 2).

Aims and objectives Improve access across Scotland to an evidence based, occupational therapy led, post diagnostic intervention in dementia .

Aligned with the National Dementia Strategy 2013-161 and the ambitions in “Connecting People, Connecting Support” 20172, this project aims to build capacity within AHP services, ensuring timely access to therapy after diagnosis by:

Increasing partnership working, collaboration and communication Developing clear implementation pathways for Home Based Memory Rehab (HBMR) Improving the ability to evaluate and measure impact Expanding the AHP evidence base Developing an improvement model to support future expansion within AHP services

Methods Partnership working

A strategic partnership was formed between lead clinical staff in NHS Dumfries and

Galloway (NHS D&G), Alzheimer Scotland’s AHP consultant and Queen Margaret

University to underpin the project.

Occupational therapy teams from across Scotland were invited to participate and

supported to develop their own project charters, based on a National Charter template,

setting out their commitment to the partnership.

These have facilitated a planned process of testing new ways of working in these services

and have improved communication between national and local stakeholders.

Developing an implementation pathway for HBMR

HBMR is an evidenced based, early intervention in dementia. Developed by a specialist occupational therapist3, it is a 6-session programme based on principles of cognitive rehabilitation.

The team in NHS D&G developed a set of resources which structure the intervention and supports fidelity of provision. These have been provided for no-cost to participating teams, enabling an initial test cycle at each site including implementation, data collection and a review of process.

Collaboration and communication

In addition to ensuring access to the HBMR resources, active engagement by each of the

clinical teams within participating areas was recognised as fundamental to successful

adoption and implementation of the intervention. A range of spaces have been created

to develop, maintain and facilitate engagement.

Building capacity to evaluate outcomes

Effectively evaluating the impact of interventions is central to quality assurance and

future planning but can be difficult to achieve in practice4. To build capacity for

evaluation we:

Identified core outcomes and reviewed available measurement tools

Collaboratively agreed a basic uniform data set measuring; function/occupation (Lawton-Brody ADL scales), cognition (MoCA), self-reported memory problems, and quality of life (AQOL-8D), as well as key process indicators.

Developed paper-based and electronic spaces for teams to record data, with outcomes analyses and case management calculations embedded within these

Maintained an evaluation thread on the list serve for quick responses to issues encountered in daily practice

Initial progress resulting from the partnership is promising

There has been a positive response and commitment from occupational therapy services across Scotland with twelve areas involved in the national pilot of HBMR

Pilot testing indicates positive clinical and quality of life outcomes

Effective collaboration across both organisational levels and geography has been established and is supporting an increased rate of change in practice

Knowledge is being developed about how to support the fidelity and quality of HMBR as it is implemented in local areas

The testing of a planned evaluation methodology is progressing well

Ave

rage

num

ber

repo

rted

Pre-therapy 1 year post-therapy

3 months post-therapy

End of therapy

Reported memory problems

Reported use of HBMR strategies

all these things...the routines...have helped me tremendously and given me the

confidence to cope

Clinical outcomes

Initial evaluation in NHS D&G focussed on measuring the number of strategies learned and retained by HBMR recipients and the number of everyday problems they encountered because of memory difficulties5.

Review of measures over a year indicated that people were able to adopt and partially maintain the use of compensatory strategies over time (Fig 3).

Qualitative outcomes

A range of qualitative feedback methods are used when reviewing the HBMR process with people.

Data collected so far indicates that strategies and tools adopted during HBMR support people to maintain and re-engage with activities which they find important and meaningful.

I used to go out shopping and realise I didn’t have any money. Now when I go I

look at my list on the cupboard that reminds me what I need to take...my

stick...my money...my keys...my handbag

Partnership, collaboration and communication

The range of communication structures used have helped ensure all participating services can contribute to shared decisions and collaborative problem solving. To date we have held: 2 national workshops 1 webex 9 teleconferences Membership of the listserve and posts about HBMR have steadily increased (Fig 5).

Total number of group members Total number posts

Figure 5: HBMR Listserve subscription and post activity by month

Figure 1: NHS Boards

Currently piloting HBMR

Figure 2: Coverage of national >30

population in participating boards

Realising I have the skills... I can

still be responsible for myself…

makes me happy

Conclusions Next Steps

1. Review of current collaborative test cycle in summer 2017

2. Establish if positive clinical and qualitative outcomes are replicated across Scotland

3. Review and update HBMR resources including branding for NHS Scotland use

4. Progress from the current test cycle into future research work to consolidate the

evidence base and explore improvement options

5. Develop an initial model for successful sharing and implementation of other AHP

interventions for post diagnostic support in dementia

6. Consider expanding the reach of occupational therapy led HBMR across integrated and

social care providers

Figure 3: HBMR strategy use and memory problems

Not offering HBMR but discussing

inclusion in pilot phase 2