Primary Care–Based Memory Clinics: Expanding Capacity for Dementia Care

Abstract

The implementation in Ontario of 15 primary-care-based interprofessional memory clinics represented a unique model of team-based case management aimed at increasing capacity for dementia care at the primary-care level. Each clinic tracked referrals; in a subset of clinics, charts were audited by geriatricians, clinic members were interviewed, and patients, caregivers, and referring physicians completed satisfaction surveys. Across all clinics, 582 patients were assessed, and 8.9 per cent were referred to a specialist. Patients and caregivers were very satisfied with the care received, as were referring family physicians, who reported increased capacity to manage dementia. Geriatricians' chart audits revealed a high level of agreement with diagnosis and management. This study demonstrated acceptability, feasibility, and preliminary effectiveness of the primary-care memory clinic model. Led by specially trained family physicians, it provided timely access to high-quality collaborative dementia care, impacting health service utilization by more-efficient use of scarce geriatric specialist resources.

Prevalence and management of dementia in primary care practices with electronic medical records: a report from the Canadian Primary Care Sentinel Surveillance Network

“…Reasons for dementia diagnoses occurring in specialist practices rather than primary care are multifaceted and include primary care providers having a lack of confidence in dementia knowledge and support resources; concern about misdiagnosis; perception of usefulness of diagnosis and treatment options; and lack or mistrust of screening tools. 20,22,23 In recent years, new models for dementia care have become widespread in primary care practices, 24 which may facilitate the management of these patients in that setting.…”

“…We used BMI values recorded in the EMR; if no value was present, we calculated it using the most recent height and weight values. We classified the BMI values as underweight (< 18), normal (18)(19)(20)(21)(22)(23)(24), overweight (25)(26)(27)(28)(29) and obese (≥ 30). We determined residence in rural or urban areas using the second digit of the patient's postal code (0 indicates rural; other values indicate urban).…”

“…39 Efforts to improve the diagnosis and management of dementia in primary care include the implementation of primary care-based memory clinics, 24 which attempt to capitalize on the particular expertise of family physicians with specific interest in the disease. Differentiating between different types of dementia is not currently possible within the CPCSSN database for reasons associated with data-recording behaviour among physicians, nor does CPCSSN data include information on other important aspects of community-based care, such as counselling, home care and advanced care planning.…”

Quality of Dementia Care in the Community: Identifying Key Quality Assurance Components

“…Many of these have been established as primary care-based memory clinics (PCMCs). (4–7,9,10,12,13) Initial evaluations suggest that PCMCs can provide timelier assessment, lead to a high degree of satisfaction among referring physicians, patients, and caregivers, and streamline access to specialists. (11–13) In order to retain the fidelity of such programs and consistency with initial training and practice guidelines, and thus prevent ‘practice drift’ and ensure ongoing high quality of care, quality assurance frameworks are needed.…”

Education to Improve Dementia Care:

“…Table 4, continued primary care physician. 34 This care model has demonstrated ability to address several challenges associated with dementia care in primary care practice such as timely access to diagnosis, assessment of driving concerns, and need for interdisciplinary care. 35 Such practice setting and system-level initiatives may be complementary to brief CME opportunities, as the one presented here for physicians and other brief programs targeting interprofessional groups, 36 which aim to develop skills at an individual clinician level.…”