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

  • Linda Lee (a1) (a2), Loretta M. Hillier (a3) (a4), George Heckman (a5) (a6) (a7), Micheline Gagnon (a7), Michael J. Borrie (a4) (a8) (a9), Paul Stolee (a5) and David Harvey (a10)...

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.

La mise en oeuvre en l’Ontario de 15 cliniques interprofessionnelles des troubles de la mémoire à base de soins primaires représente un modèle unique de gestion de cas en équipe, visant à accroître la capacité de traitement de la démence au niveau des soins primaires. Chaque clinique a suivi les patients; dans un sous-ensemble des cliniques, des graphiques ont été vérifiés par les gériatres, les membres de la clinique ont été interrogés, et les patients, les soignants et les médecins traitants ont rempli des questionnaires de satisfaction. Dans toutes les cliniques, 582 patients ont été évalués, et 8,9 pour cent ont été adressés à un spécialiste. Les patients et les soignants étaient très satisfaits des soins reçus, de même que les médecins traitants de la famille, qui ont déclaré une augmentation de la capacité à gérer la démence. La vérification des dossiers des gériatres a révélé un niveau élevé d'accord avec le diagnostic et la gestion. Cette étude a démontré l'acceptabilité, la faisabilité et l'efficacité préliminaire du modèle de clinique des troubles de la mémoire de soins primaires. Dirigée par les médecins de famille spécialement formés, il a fourni un accès en temps opportun à la haute qualité des soins de la démence collaboratives, affectant recours aux services de santé par une utilisation plus efficace des maigres ressources spécialisées en gériatrie.

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Corresponding author

La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to:Linda Lee, M.D., MCIScThe Centre for Family MedicineMcMaster UniversityDepartment of Family Medicine10B Victoria St. SouthKitchener, ON N2G 1C5(lee.linda.lw@gmail.com)

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*

This study was funded by the Canadian Institutes of Health Research – Institute of Health Services and Policy Research Catalyst Grant Program: Primary and Community-Based Healthcare, Grant No: 212207, the Department of Family Medicine, McMaster University, and the Centre for Family Medicine Family Health Team. The authors thank Sheri Lynn Kane and Seagram Chandrakumar for conducting chart audits as well as the memory clinic team members from each participating Family Health Team for their data collection efforts.

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References

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