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A five-step approach for developing and implementing a Rural Primary Health Care Model for Dementia: a community–academic partnership

  • Debra Morgan (a1), Julie Kosteniuk (a2), Dallas Seitz (a3), Megan E. O’Connell (a4), Andrew Kirk (a5), Norma J. Stewart (a6), Jayna Holroyd-Leduc (a7), Jean Daku (a8), Tracy Hack (a9), Faye Hoium (a10), Deb Kennett-Russill (a11) and Kristen Sauter (a12)...



This study is aimed at developing a Rural Primary Health Care (PHC) Model for delivering comprehensive PHC for dementia in rural settings and addressing the gap in knowledge about disseminating and implementing evidence-based dementia care in a rural PHC context.


Limited access to specialists and services in rural areas leads to increased responsibility for dementia diagnosis and management in PHC, yet a gap exists in evidence-based best practices for rural dementia care.


Elements of the Rural PHC Model for Dementia were based on seven principles of effective PHC for dementia identified from published research and organized into three domains: team-based care, decision support, and specialist-to-provider support. Since 2013 the researchers have collaborated with a rural PHC team in a community of 1000 people in the Canadian province of Saskatchewan to operationalize these elements in ways that were feasible in the local context. The five-step approach included: building relationships; conducting a problem analysis/needs assessment; identifying core and adaptable elements of a decision support tool embedded in the model and resolving applicability issues; implementing and adapting the intervention with local stakeholders; and sustaining the model while incrementally scaling up.


Developing and sustaining relationships at regional and PHC team levels was critical. A comprehensive needs assessment identified challenges related to all domains of the Rural PHC Model. An existing decision support tool for dementia diagnosis and management was adapted and embedded in the team’s electronic medical record. Strategies for operationalizing other model elements included integrating team-based care co-ordination into the decision support tool and family-centered case conferences. Research team specialists provided educational sessions on topics identified by the PHC team. This paper provides an example of a community-based process for adapting evidence-based practice principles to a real-world setting.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Debra Morgan, Professor and Chair of Rural Health Delivery, Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, Canada S7N 2Z4. E-mail:


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Aarons, G, Green, A, Palinkas, L, Self-Brown, S, Whitaker, D, Lutzker, J, Silovsky, J, Hecht, D Chaffin, M (2012) Dynamic adaptation process to implement an evidence-based child maltreatment intervention. Implementation Science 7, 32.
Alzheimer’s Disease International (ADI) (2015) World Alzheimer Report 2015: the global impact of dementia. Retrieved 2 October 2017 from
Alzheimer’s Disease International (ADI) (2016) World Alzheimer Report 2016: improving healthcare for people living with dementia: coverage, quality and costs now and in the future. Retrieved 15 September 2017 from
Aminzadeh, F, Molnar, F, Dalziel, W Ayotte, D (2012) A review of barriers & enablers to diagnosis and management of persons with dementia in primary care. Canadian Geriatrics Journal 15, 8594.
Auer, S, Span, E Reisberg, B (2015) Dementia service centres in Austria: a comprehensive support and early detection model for persons with dementia and their caregivers – theoretical foundations and model description. Dementia 14, 513527.
Bergman, H (2009) Meeting the challenge of Alzheimer’s Disease and related disorders. Report of the Committee of Experts for the Development of an Action Plan on Alzheimer’s Disease and Related Disorders. Retrieved 1 October 2017 from
Bourke, L, Humphreys, J, Wakerman, J Taylor, J (2010) From ‘problem describing’ to ‘problem-solving’: challenging the deficit view of remote and rural health. Australian Journal of Rural Health 18, 2015–209.
Brush, B, Baiardi, J Lapides, S (2011) Moving toward synergy: lessons learned in developing and sustaining community-academic partnerships. Progress in Community Health Partnerships 5, 2734.
Cabassa, L, Gomes, A, Meyreles, Q, Capitelli, L, Younge, R, Dragatsi, D, Alvarez, J, Manrique, Y Lewis-Fernández, R (2014) Using the collaborative intervention planning framework to adapt a health-care manager intervention to a new population & provider group to improve the health of people with serious mental illness. Implementation Science 9, 178.
Callahan, C, Boustani, M, Unverzagt, F, Austrom, M, Damush, T, Perkins, A, Fultz, B, Hui, S, Counsell, S Hendrie, H (2006) Effectiveness of collaborative care for older adults with AD in primary care. JAMA 295, 21482157.
Callahan, C, Boustani, M, Weiner, M, Beck, R, Livin, L Kellams, J (2011) Implementing dementia care models in primary are settings: the Aging Brain Care Medical Home. Aging & Mental Health 15, 512.
Dal Bello-Haas, V, Cammer, A, Morgan, D, Stewart, N Kosteniuk, J (2014) Rural and remote dementia care challenges and needs: perspectives of formal and informal care providers residing in Saskatchewan, Canada. Rural and Remote Health 14, 2747.
Damschroder, L, Aron, D, Keith, R, Kirsh, S, Alexander, J Lowery, J (2009) Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science 4, 50.
Elliot, D (2012) The age distribution of the Saskatchewan population. Sask Trends Monitor 24, 210.
Engedal, K, Gausdal, M, Gjora, L Haurgen, PK (2012) Assessment of dementia by a primary health care team cooperating with a family doctor: the Norwegian model. Dementia and Geriatric Cognitive Disorders 34, 263270.
Feldman, H Estabrooks, C (2017) The Canadian dementia challenge: ensuring optimal care and services for those at risk or with dementia throughout the country. Canadian Journal of Public Health 108, e95e97.
Fixen, D, Naoom, S, Blase, K, Friedman, R Wallace, F (2005) Implementation research: a synthesis of the literature. Retrieved 15 September 2017 from
Greenway-Crombie, A, Snow, P, Disler, P, Davis, S Pond, D (2012) Influence of rurality on diagnosing dementia in Australian general practice. Australian Journal of Primary Health Care 18, 178184.
Innes, A, Morgan, D Kosteniuk, J (2011) Dementia care in rural and remote settings: a systematic review of informal/family caregiving. Maturitas 68, 3446.
Innes, A, Szymczynska, P Stark, C (2014) Dementia diagnosis and post-diagnostic support in Scottish rural communities: experiences of people with dementia and their families. Dementia 13, 233247.
Israel, B, Schulz, A, Parker, E Becker, A (1998) Review of community-based research: assessing partnership approaches to improve public health. Annual Review of Public Health 19, 173202.
Jansen, S, Haveman-Nies, A, Duijzer, G, Beek, J, Hiddink, G Feskens, E (2013) Adapting the SLIM diabetes prevention intervention to a Dutch real-life setting: joint decision making by science and practice. BMC Public Health 13, 457.
Kosteniuk, J, Morgan, D Dal Bello-Haas, V (2014a) Dementia learning needs assessment for Sun Country Health Region: Survey Report. Retrieved 1 October 2017 from
Kosteniuk, J, Morgan, D, Innes, A, Keady, J, Stewart, N, D’Arcy, C Kirk, A (2014b) Who steers the ship? Rural family physicians views on collaborative care models for patients with dementia. Primary Health Care Research & Development 15, 104110.
Kosteniuk, J, Morgan, D, O’Connell, ME, Dal Bello-Haas, V Stewart, N (2016a) Focus on dementia care: continuing education preferences, challenges, and catalysts among rural home care providers. Educational Gerontology 42, 608620.
Kosteniuk, J, Morgan, D, O’Connell, ME, Kirk, A, Crossley, M, Teare, G, Stewart, N, Dal Bello-Haas, V, Forbes, D, Innes, A Quail, J (2015a) Incidence and prevalence of dementia in linked administrative health data in Saskatchewan, Canada: a retrospective cohort study. BMC Geriatrics 15, 116.
Kosteniuk, J, Morgan, D, O’Connell, ME, Kirk, A Stewart, N (2016b) A baseline study of the dementia care landscape in sun country health region: a report by the Rural Dementia Action Research (RaDAR) Team. Retrieved 30 September 2017 from
Kosteniuk, J, Morgan, D, Quail, J, Teare, G, Kulyk, K, O’Connell, ME, Kirk, A, Crossley, M, Stewart, N, Dal Bello-Haas, V, McBain, L, Mou, H, Forbes, D, Innes, A, Bracken, J Parrott, E (2015b) A multi-method investigation of dementia and related services in Saskatchewan: final report and recommendations. Retrieved 14 September 2017 from
Lee, L, Hillier, L, Stolee, P, Heckman, G, Gagnon, M, McAiney, C Harvey, D (2010) Enhancing dementia care: a primary care-based memory clinic. Journal of the American Geriatrics Society 58, 2197–204.
Lee, S, Altschul, I Mowbray, C (2008) Using planned adaptation to implement evidence-based programs with new populations. American Journal of Community Psychology 41, 290303.
Lourida, I, Abbott, R, Roger, M, Lang, I, Stein, K, Kent, B Thompson Coon, J (2017) Dissemination and implementation research in dementia care: a systematic scoping review and evidence map. BMC Geriatrics 17, 147.
McAiney, C, Hillier, L, Stolee, P, Harvey, D Michael, M (2012) Throwing a lifeline: the role of First Link in enhancing support for individuals with dementia and their caregivers. Neurodegenerative Disease Management 2, 623638.
McKleroy, V, Galbraith, J, Cummings, B, Jones, P, Harshbarger, C, Collins, C, Gelaude, D Carey, J, the ADAPT team (2006) Adapting evidence-based behavioural interventions for new settings and target populations. AIDS Education and Prevention 18, 5973.
Milbourne, P (2012) Growing old in rural places. Journal of Rural Studies 28, 315317.
Misfeldt, R, Sutre, E, Oekle, N Hepp, S (2017) Creating high performance primary health care teams in Alberta, Canada: mapping out the key issues using a sociological model. Journal of Interprofessional Education & Practice 6, 2732.
Moazzami, B (2015) Strengthening rural Canada: fewer and older: population and demographic crossroads in rural Saskatchewan. Retrieved 10 November 2017 from
Moore, A, Patterson, C, Lee, L, Vedel, I Bergman., H (2014) Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia: recommendations for family physicians. Canadian Family Physician 60, 433438.
Morgan, D, Crossley, M, Kirk, A, D’Arcy, C, Stewart, N, Biem, J, Forbes, D, Harder, S, Basran, J, Dal Bello-Haas, V McBain, L (2009) Improving access to dementia care: development and evaluation of a rural and remote memory clinic. Aging and Mental Health 13, 1730.
Morgan, D, Crossley, M, Stewart, N, Kirk, A, Forbes, D, D’Arcy, C, Dal Bello-Haas, V, McBain, L, O’Connell, ME, Bracken, J, Kosteniuk, J Cammer, A (2014a) Evolution of a community-based participatory approach in a Rural and Remote Dementia Care Research Program. Progress in Community Health Partnerships 8, 337345.
Morgan, D, Innes, A Kosteniuk, J (2011) Dementia care in rural and remote settings: A systematic review of formal or paid care. Maturitas 68, 1733.
Morgan, D, Kosteniuk, J, Crossley, M, Kirk, A, O’Connell, ME, Stewart, N, Forbes, D, Dal Bello-Haas, V, Innes, A, Keady, J, Vaitheswaran, S Murdoch, A (2012) Report on the Community-Based Primary Healthcare Team Grant Planning Session, October 17, 2011. Retrieved 7 October 2017 from
Morgan, D, Kosteniuk, J, O’Connell, ME, Dal Bello-Haas, V, Stewart, N Karunanayake, C (2016) Dementia-related work activities of home care nurses and aides: frequency, perceived competence and continuing education priorities. Educational Gerontology 42, 120135.
Morgan, D, Kosteniuk, J, Stewart, N, O’Connell, ME, Kirk, A, Crossley, M, Dal Bello-Haas, V, Forbes, D Innes, A (2015) Availability and primary health care orientation of dementia-related services in rural Saskatchewan, Canada. Home Health Care Services Quarterly 34, 137158.
Morgan, D, Walls-Ingram, S, Cammer, A, O’Connell, ME, Crossley, M, Dal Bello-Haas, V, Forbes, D, Innes, A, Kirk, A Stewart, N (2014b) Informal caregivers’ hopes and expectations of a referral to a memory clinic. Social Science & Medicine 102, 111118.
O’Connell, ME, Crossley, M, Cammer, A, Morgan, D, Allingham, W, Cheavins, B, Dalziel, D, Lemire, M, Mitchell, S Morgan, E (2014) Development and evaluation of a Telehealth videoconferenced support group for rural spouses of persons diagnosed with atypical early-onset dementias. Dementia 13, 382395.
Peters, D, Tran, N Taghreed, A (2013) Implementation research in health: a practical Guide. Retrieved 2 September 2017 from
Pond, CD (2017) The role of primary care in identification and ongoing management of dementia: a time of transition. International Psychogeriatrics 29, 14091411.
Richard, L, Torres, S, Tremblay, M, Chiocchio, F, Litvak, E, Fortin-Pellerin, L Beauder, N (2015) An analysis of the adaptability of a professional development program in public health: results from the ALPS study. BMC Health Services Research 15, 233.
Ritchie, S, Wabano, M, Beardy, J, Curran, J, Orkin, A, VanderBurgh, D Young, N (2013) Community-based participatory research with Indigenous communities: the proximity paradox. Health & Place 24, 183189.
Rycroft-Malone, J, Burton, C, Bucknail, T, Graham, I, Hutchinson, A Stacey, D (2016) Collaboration and co-production of knowledge in healthcare: opportunities and challenges. International Journal of Health Policy and Management 5, 221223.
Seifer, S (2006) Building and sustaining community-institutional partnerships for prevention research: findings from a national collaborative. Journal of Urban Health 83, 9891003.
Seitz, D (2012) Primary Care-Dementia Assessment & Treatment Algorithm (PC-DATA). Retrieved 1 October 2017 from
Shalowitz, M, Isacco, A, Barquin, N, Clark-Kauffman, D, Delger, P, Nelson, D, Quinn, A Wagenaar, K (2009) Community-based participatory research: a review of the literature with strategies for community engagement. Journal of Developmental and Behavioral Pediatrics 30, 350361.
Szymcynska, P, Innes, A, Mason, A Stark, C (2011) A review of diagnostic process and postdiagnostic support for people with dementia in rural areas. Journal of Primary Care & Community Health 2, 262276.
Vickrey, B, Mittman, B, Connor, K, Pearson, M, Della Penna, R, Ganiats, T, DeMonte, R Jr, Chodosh, J, Cui, X, Vassar, S, Duan, N Lee, M (2006) The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Annals of Internal Medicine 145, 713726.
Wallerstein, N Duran, B (2010) Community-based participatory research contributions to intervention research. American Journal of Public Health 100 (Suppl 1), S4046.
World Health Organization and Alzheimer’s Disease International (2012) Dementia: a public health priority. Retrieved 6 October 2017 from
Yano, E, Green, L, Glanz, K, Ayanian, J, Mittman, B, Chollette, V Ruberstein, L (2012) Implementation and spread of interventions into the multilevel context of routine practice and policy: implications for the cancer care continuum. Journal of the National Cancer Institute. Monographs 44, 8699.
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