Is the effectiveness of memory assessment services associated with their structural and process characteristics?
OBJECTIVE
The aim of this study was to investigate whether structural and process characteristics of memory assessment services (MASs) are associated with outcomes (changes in patients' health-related quality of life (HRQL), carers' HRQL and carers' burden) over the first 6 months following the first appointment.


METHODS
Data from 785 patients referred to 69 MASs and 511 of their lay carers, collected at the first appointment and 6 months later. Data on MAS characteristics were collected using a questionnaire at baseline. We used multilevel linear regression models to explore the associations of patients' HRQL and carers' outcomes with structural and process characteristics of MASs. Analyses were conducted on the full sample of patients and carers, and separately on those patients diagnosed with dementia.


RESULTS
None of the structural (skill mix, workload, volume, provision of clinical assessments and provision of psychosocial support) or process (waiting time, length and number of appointments, anti-dementia drug use and psychosocial interventions use) characteristics included in the analyses were associated with patients' or carers' outcomes at 6 months, apart from the presence of allied health professionals (AHPs), which was associated with a DEMQOL score 2.7 points higher. When only those with a diagnosis of dementia were considered, the association with presence of AHPs was no longer observed.


CONCLUSIONS
Apart from involving AHPs, alterations to the way MASs are structured or function appear unlikely to improve their effectiveness in improving patients' and carers' HRQL. It is possible that the characteristics of MASs may influence patients' and carers' experience, but this was not studied. Copyright © 2017 John Wiley & Sons, Ltd.
Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
Min Hae
http://orcid.org/0000-0002-2563-4910
MH
Park
Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
Nick
N
Black
Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK.
Craig W
CW
Ritchie
Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
A A Jolijn
AAJ
Hendriks
Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
Sarah C
SC
Smith
D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel / Q000706:statistics & numerical data; D017028:Caregivers / Q000523:psychology; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis*; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011788:Quality of Life; D012044:Regression Analysis
Dementia; caregiver burden; health-related quality of life; memory assessment services; memory clinics