Characterising Australian memory clinics: current practice and service needs informing national service guidelines

Abstract

Background Memory clinics (MCs) play a key role in accurate and timely diagnoses and treatment of dementia and mild cognitive impairment. However, within Australia, there are little data available on current practices in MCs, which hinder international comparisons for best practice, harmonisation efforts and national coordination. Here, we aimed to characterise current service profiles of Australian MCs. Methods The ‘Australian Dementia Network Survey of Expert Opinion on Best Practice and the Current Clinical Landscape’ was conducted between August-September 2020 as part of a larger-scale Delphi process deployed to develop national MC guidelines. In this study, we report on the subset of questions pertaining to current practice including wait-times and post-diagnostic care. Results Responses were received from 100 health professionals representing 60 separate clinics (45 public, 11 private, and 4 university/research clinics). The majority of participants were from clinics in metropolitan areas (79%) and in general were from high socioeconomic areas. While wait-times varied, only 28.3% of clinics were able to offer an appointment within 1-2 weeks for urgent referrals, with significantly more private clinics (58.3%) compared to public clinics (19.5%) being able to do so. Wait-times were less than 8 weeks for 34.5% of non-urgent referrals. Only 20.0 and 30.9% of clinics provided cognitive interventions or post-diagnostic support respectively, with 7.3% offering home-based reablement programs, and only 12.7% offering access to group-based education. Metropolitan clinics utilised neuropsychological assessments for a broader range of cases and were more likely to offer clinical trials and access to research opportunities. Conclusions In comparison to similar countries with comprehensive government-funded public healthcare systems (i.e., United Kingdom, Ireland and Canada), wait-times for Australian MCs are long, and post-diagnostic support or evidence-based strategies targeting cognition are not common practice. The timely and important results of this study highlight a need for Australian MCs to adopt a more holistic service of multidisciplinary assessment and post-diagnostic support, as well as the need for the number of Australian MCs to be increased to match the rising number of dementia cases.

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

“…This is an extended memory clinic model. Challenges to model implementation are that few memory clinics currently are resourced to offer post-diagnostic support services [37 ▪ ,38 ▪ ], costs are high [39] and there is need to establish more clinics and develop the workforce [37 ▪ ].…”

A new one‐stop interdisciplinary cognitive clinic model tackles rural health inequality and halves the time to diagnosis: Benchmarked against a national dementia registry

“…A recent survey of 60 Australian cognitive clinics highlighted the need for clinics to adopt a more holistic interdisciplinary assessment. 8 In addition, qualitative research exploring the views of GPs, people with dementia, and other community members in Australia, suggested a 'one-stop' approach would be preferable-in terms of speeding up the time to diagnosis and to reduce inequity of access, especially for those living outside metropolitan areas. 12 Of the seven Australian States, Tasmania has the oldest demographic profile and the highest rates of modifiable dementia risk factors.…”

“…Similar to most other countries, in Australia, there is considerable variation in pathways to a diagnosis, and there are insufficient Memory Clinics to meet demand 8 . Australian Clinical Practice Guidelines recommend that people experiencing cognitive symptoms should be assessed by comprehensive memory services 9 but most Australians have to navigate a sequence of visits to private clinics or public hospitals 10 .…”

“…In 2020, the Australian Dementia Network (ADNeT) brought together leading researchers, clinicians, and consumers to create a network for dementia prevention, treatment and care. A recent survey of 60 Australian cognitive clinics highlighted the need for clinics to adopt a more holistic interdisciplinary assessment 8 . In addition, qualitative research exploring the views of GPs, people with dementia, and other community members in Australia, suggested a ‘one‐stop’ approach would be preferable—in terms of speeding up the time to diagnosis and to reduce inequity of access, especially for those living outside metropolitan areas 12 …”

Forward with Dementia: process evaluation of an Australian campaign to improve post-diagnostic support

“…When people with dementia and carers do not receive adequate post-diagnostic support, they may not know how to best manage their dementia, may not be receiving optimal treatment, and may feel lost or hopeless [6]. Reasons for not getting su cient post-diagnostic support include reluctance to use services and supports [7], di culty accessing services [8,9], and insu cient provision of services [5,10,11,12]. Therapeutic nihilism and stigma amongst health professionals and the public are also barriers to provision and accessing supports [13,14].…”