Question: For people with dementia how effective is a continuity of care model (particularly in terms of staff) compared to any other model of care in achieving improved clinical outcomes? Is there any evidence that this model is more effective in adults with dementia than the general older population?

Answer:

One high quality Cochrane review, and a second poor quality systematic review provided the majority of the data to inform this evidence summary. Two randomised controlled trials (RCTs) and an analysis of data from an RCT published elsewhere provided some additional information. All of the primary studies were included in the second systematic review and all had important methodological weaknesses. The Cochrane review concluded that the available evidence on the effectiveness of a primary-care model compared with team nursing or usual care was unconvincing; this conclusion is likely to be reliable. By contrast, the conclusion of the second review, that the effectiveness of case management interventions is dependent upon their intensity and degree of integration with other aspects of care, is not adequately supported by the data presented. The results of the studies included in the second review were variable and not strongly supportive of the effectiveness of case management interventions.

No studies were identified which provided information on the effectiveness of continuity of care interventions in adults with dementia compared to their effectiveness in the general older population.

This summary suggests that the evidence base on continuity of care interventions in the elderly is currently weak. High quality randomised controlled trials are needed to provide reliable assessments of the effectiveness of continuity of care interventions on patient-relevant outcomes. Standardisation of interventions is also needed.