Specialist and family physician collaboration: Insights from primary care‐based memory clinics

Abstract

Given limited available geriatric specialists and complexity of dementia care, there is a need for greater collaboration between primary care and specialists to better meet the needs of persons with dementia. Meaningful family physician-specialist collaboration has the potential to improve health outcomes, timely access to care and more appropriate healthcare resource utilisation. Primary Care Collaborative Memory Clinics (PCCMCs), which include specialist support, provide a significant opportunity for studying the family physician-specialist interface. This study aimed to explore the nature of collaborative relationships between memory clinic family physicians and specialists caring for persons with memory concerns in PCCMCs across Ontario, Canada. Family physicians (N = 71) attending an education session and specialists (N = 21) completed a survey in the fall of 2017 that measured frequency and amount of collaboration, perceptions of their relationship and identified factors that enable and challenge collaboration. Descriptive statistics were generated for quantitative data and themes for responses to open-ended questions were explored using descriptive qualitative content analysis. Specialists and memory clinic family physicians valued their collaboration particularly as related to capacity building for dementia care and desired more time devoted to collaboration. Identified enablers and barriers to collaboration have implications for further integration of specialist support to potentially support improved patient care and further build capacity in primary care to manage dementia care. Opportunities exist for expanding and more intentionally supporting how family physicians and specialists interact with the creation of more formalised processes to support optimal collaboration, including a clear delineation of roles, responsibilities and expectations, more formally planned and structured relationship building and monitoring, identifying and addressing unique barriers to collaboration and use of a variety of methods of communication. Study findings have implications for how specialists and family physicians communicate and collaborate in other programmes for complex chronic conditions. K E Y W O R D S collaboration, dementia care, family physicians, memory clinics, primary care, specialists | e523 LEE Et aL.

Caring for older patients with advanced chronic kidney disease and considering their needs: a qualitative study

“…However, in this same study, a minority of nephrologists actually presented conservative kidney management as an option to their patients. As we found that PCPs felt strongly about guiding their patients through the decision-making process, a collaborative model in which both the PCP and nephrologist assume distinct roles (e.g., information provider and treatment decision navigator, respectively) could potentially improve ESRD decision-making for this patient population [12,[28][29][30].…”

The Two-Step Strategy Could Be Inadequate and Counteracting to Diagnose Prodromal Dementia or Mild Cognitive Impairment

“…Our proposal fits well into the primary care-based memory clinic models that involve the intervention of specialists (Greaves and Greaves, 2011;Greaves et al, 2015) or interdisciplinary teams (Callahan et al, 2006;Lee et al, 2010Lee et al, , 2014Lee et al, , 2019Fougère et al, 2017) working in a primary care setting to increase the ability to treat and manage dementia at the primary care level. In this context, the novelty of our proposal is that it focuses on the specific problem of the fallible detection of prodromal dementia or MCI in primary care.…”

“…In this context, the novelty of our proposal is that it focuses on the specific problem of the fallible detection of prodromal dementia or MCI in primary care. It is interesting to note that some of the primary care-based memory clinic projects have been ongoing for some years and have demonstrated acceptability, feasibility, and preliminary effectiveness (Callahan et al, 2006 ; Lee et al, 2010 , 2014 , 2019 ; Greaves and Greaves, 2011 ; Greaves et al, 2015 ; Fougère et al, 2017 ).…”

Specialist LINK and primary care network clinical pathways - a new approach to patient referral: a cross-sectional survey of awareness, utilization and usability among family physicians in Calgary

“…In many cases, family physicians might be able to deal with patient problems but refer patients to specialists to make sure patients are getting the right treatment. Due to quick communication with specialists, family physicians would be able to look after many cases that otherwise would have been referred to specialists [3,12]. As identified by Barua [1], and Liddy et al [3], waiting for specialist care has been one of the major barriers to health care access in Canada [13].…”