title: Healthcare organisation and delivery for people with dementia and comorbidity: a qualitative study exploring the views of patients, carers and professionals.
abstract: People living with dementia (PLWD) have a high prevalence of comorbidty. The aim of this study was to explore the impact of dementia on access to non-dementia services and identify ways of improving service delivery for this population.
  
  
  
  Qualitative study involving interviews and focus groups. Thematic content analysis was informed by theories of continuity of care and access to care.
  
  
  
  Primary and secondary care in the South and North East of England.
  
  
  
  PLWD who had 1 of the following comorbidities-diabetes, stroke, vision impairment, their family carers and healthcare professionals (HCPs) in the 3 conditions.
  
  
  
  We recruited 28 community-dwelling PLWD, 33 family carers and 56 HCPs. Analysis resulted in 3 overarching themes: (1) family carers facilitate access to care and continuity of care, (2) the impact of the severity and presentation of dementia on management of comorbid conditions, (3) communication and collaboration across specialities and services is not dementia aware. We found examples of good practice, but these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD.
  
  
  
  This study suggests that, in order to improve access and continuity for PLWD and comorbidity, a significant change in the organisation of care is required which involves: coproduction of care where professionals, PLWD and family carers work in partnership; recognition of the way a patient's diagnosis of dementia affects the management of other long-term conditions; flexibility in services to ensure they are sensitive to the changing needs of PLWD and their family carers over time; and improved collaboration across specialities and organisations. Research is needed to develop interventions that support partnership working and tailoring of care for PLWD and comorbidity.
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK.
authors.forename: Frances
authors.initials: F
authors.lastname: Bunn
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Burn
authors.affiliation: Institute for Health and Society, Newcastle University, Newcastle, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Robinson
authors.affiliation: Institute for Health and Society, Newcastle University, Newcastle, UK.
authors.forename: Marie
authors.initials: M
authors.lastname: Poole
authors.affiliation: Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK.
authors.forename: Greta
authors.initials: G
authors.lastname: Rait
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
authors.affiliation: Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Johan
authors.initials: J
authors.lastname: Schoeman
authors.affiliation: East London Foundation Trust, London, UK.
authors.forename: Sam
authors.identifier: 0000-0003-1714-9963
authors.initials: S
authors.lastname: Norton
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Goodman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000706:statistics & numerical data*; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration; D003704:Dementia / Q000453:epidemiology / Q000628:therapy*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D004739:England / Q000453:epidemiology; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D014786:Vision Disorders / Q000453:epidemiology / Q000628:therapy*
keywords: DIABETES & ENDOCRINOLOGY; QUALITATIVE RESEARCH; comorbidity; vision impairment