Objective: The State of Victoria in Australia has established a statewide network of Cognitive Dementia and Memory Service (CDAMS) clinics designed to provide comprehensive assessment, diagnosis, care planning and referral services to people with early dementia, and their caregivers and/or families. The service model incorporates a home visit and family conference in addition to specialist clinical assessment. The current study was designed to assess the utility and quality of this service as perceived by the patients' caregivers and referring general practitioners (GPs).
Design: A retrospective survey of the caregivers of patients who attended a clinic over a 12-month period; and a sample of GPs who referred patients to a clinic(s).
Materials and Methods: Questionnaires were mailed by 9 of the 13 clinics to the caregivers of people who had attended in the year prior to the study. Opinions of five domains of the service were measured using a previously published scale: (1) communication of the results; (2) provision of diagnostic information; (3) attitude of the clinician; (4) usefulness of the medical assessment; and (5) information and advice to caregivers. A random sample of general practitioners (GPs) who had referred patients to the clinics were interviewed by telephone on three aspects of service (domains 2, 4, 5). Additional open-ended questions on the positives and negatives of the service, and ideas for future improvement were analyzed thematically.
Results: A total of 210 caregivers replied to the survey and 36 GPs were interviewed. Caregivers and GPs were overwhelmingly positive about the services provided by CDAMS. Comparisons of sub-scale scores with those from a comparable Dutch study indicated the Victorian groups were more satisfied with the Clinics in all domains than were their European counterparts. Caregivers were most positive about the way the clinic staff responded to them and the diagnostic and assessment information provided, and were least positive about information and advice regarding management of their relative's conditions. The general practitioners were most positive about diagnostic information and the usefulness of the assessment, and least positive about the advice they received regarding the support capacity of the family and community resources. Qualitative responses from caregivers suggested that clinic attendance improved their morale and client well-being.
Conclusion: Victoria's Cognitive Dementia and Memory Service is providing a valuable service to caregivers and GPs. The findings of this study indicated that the service could be strengthened through improved information and advice to caregivers and GPs on how to deal with the illness and strategies for providing support and care. Moreover the findings suggest that service practice should be revised to facilitate greater collaboration with the patient's GP in the care planning process.
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