Factors influencing the commissioning and implementation of health and social care interventions for people with dementia: commissioner and stakeholder perspectives

Abstract

AbstractBackgroundDespite several interventions demonstrating benefit to people living with dementia and their caregivers, few have been translated and implemented in routine clinical practice. There is limited evidence of the barriers and facilitators for commissioning and implementing health and social care interventions for people living with dementia. The aim of the current study was to explore the barriers and facilitators to commissioning and implementing a dementia friendly exercise and physical activity-based intervention (PrAISED (Promoting Activity, Stability and Independence in Early Dementia and Mild Cognitive Impairment)) in practice.MethodsQualitative semi-structured interviews were conducted with stakeholders from a range of backgrounds including individuals from universities, research centres, the voluntary and community sector, health and social care, and local government in England. The Consolidated Framework for Intervention Research (CFIR) was used to guide the design and analysis. Fourteen participants took part, including commissioning managers, service managers, partnership managers, charity representatives, commercial research specialists, academics/researchers, and healthcare professionals.ResultsData were represented in 33 constructs across the five CFIR domains. Key barriers included cost/financing, the culture of commissioning, and available resources. Key facilitators included the adaptability of the intervention, cosmopolitanism/partnerships and connections, external policy and incentives, and the use of already existing (and untapped) workforces. Participants identified a need for greater support for people diagnosed with dementia and their caregivers immediately post dementia diagnosis.ConclusionSeveral barriers and facilitators for commissioning and implementing health and social care interventions for people with dementia were identified which need to be addressed. Recommended actions to facilitate the commissioning and implementation of dementia friendly services are: 1) map out local needs, 2) evidence the intervention including effectiveness and cost-effectiveness, 3) create/utilise networks with stakeholders, and 4) plan required resources.