A new model for general practice-led, regional, community-based, memory clinics

Abstract

Background Dementia is a major international health issue with high impact on the patient, relatives, and broader society. Routine screening for dementia is limited, despite known benefit of early detection and intervention on quality of care and patient outcomes. Screening is particularly limited in rural and regional areas, despite high burden and projected growth of dementia in these populations. The current study aimed to implement a new general practitioner (GP) led, multidisciplinary, model of care providing dementia detection and referral pathway to a community-based specialist clinic across six regional general practices. Methods Cross-sectional analysis of dementia screening and referral characteristics in the St Anthony Family Medical Practices group based in the regional area of Loddon-Mallee, Victoria. Data were collected on demographics and relevant medical history. Cognitive state was assessed using the Mini-Mental State Examination (MMSE), GP Assessment of Cognition (GPCog), and Geriatric Depression Scale (GDS). Referrals and referral outcomes were recorded for geriatrician, psycho-geriatrician, or both. Results Eight hundred and eighteenth patients over 65 years were screened, accounting for approximately 24.2% of 65 and over presentations for the practice network. Of those screened, 68.9% were indicated for referral and 30.3% of these were successfully referred. Of the indicated patients who received referrals, 34.2% declined. Many who declined referral had intermediate scores on the cognitive assessments utilized. Conclusion Standardised models of care, integrated within community services, are necessary to improve access to early detection, referral and quality management of dementia. The St Anthony Memory Service model will be invaluable in informing future service development, and in particular the development of services for people living with dementia in rural and regional communities.

Rural general practitioner confidence in diagnosing and managing dementia: A two‐stage, mixed methods study of dementia‐specific training

“…An audit of the screening patterns from the SAFMP group in the 3 years following this pilot program shows promising results with room for further improvement. 17 These results are in agreement with earlier reported positive correlations between knowledge and confidence that is evident in the theories around clinical decision-making. 25,26 Collectively, GPs in the present study suggest that locally delivered, face-to-face education and training will help in better detection and diagnosis, with many indicating that development opportunities, such as dementia training were largely located in metropolitan areas and thus not easily accessible to rural GPs.…”

“…Following the Stage 1 cross‐regional interviews, a training program was developed through a one‐day workshop that included all 28 GPs and 12 practice nurses, and facilitated by a geriatrician and a psycho‐geriatrician. This program was piloted with GPs and practice nurses in a large family medical practice in central Victoria, Australia, and then establishment as a general‐practice‐led, specialist supported memory clinic—the model of care and associated audit of this pathway and memory clinic are reported in Disler, Pascoe 17 …”

Further development needed: models of post-diagnostic support for people with dementia

“…Hence, there has been increasing research into primary care-based models, e.g. [15 ▪▪ ,35 ▪ ,36 ▪ ].…”

Enhancing post-diagnostic care in Australian memory clinics: Health professionals’ insights into current practices, barriers and facilitators, and desirable support

“…It is clear that public metropolitan clinics in Australia are developing an integrated model of care using local resources. The problem remains unresolved with regional clinics that lack local resources, although there is an example of a primary care led memory clinic in regional Victoria (Australia) that has shown effective implementation of post diagnostic continuity of care (Disler et al, 2022). The model by Disler and colleagues (2022) provides additional education of GPs and nursing staff along with access to specialist advice and collaboration with secondary care.…”

“…The problem remains unresolved with regional clinics that lack local resources, although there is an example of a primary care led memory clinic in regional Victoria (Australia) that has shown effective implementation of post diagnostic continuity of care (Disler et al, 2022). The model by Disler and colleagues (2022) provides additional education of GPs and nursing staff along with access to specialist advice and collaboration with secondary care. These components, some provided through telehealth, have facilitated diagnosis, follow-up, and linkage to available local services.…”