Effect of Primary Care‐Based Memory Clinics on Referrals to and Wait‐Time for Specialized Geriatric Services

Lee, Linda; Hillier, Loretta M.; Wilson, Julie; Gregg, Susie; Fathi, Karim; Smith, Cathy Sturdy; Smith, Matt

doi:10.1111/jgs.15169

Cited by 12 publications

(10 citation statements)

References 7 publications

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“…In Canada, less than half of individuals with Alzheimer’s disease and/or their caregivers report being told of their diagnosis (Lee & Weston, 2011). Most dementia diagnoses are unrecognized and undocumented in primary care (Paraskevaidi, Martin-Hirsch, & Martin, 2018; Lee et al, 2017). Dementia diagnoses can take months to years to confirm , and studies have demonstrated that in the early stages it is pervasively under- detected, under-diagnosed, under-disclosed, under-treated, and under-managed (Aminzadeh et al, 2012).…”

Section: Health System Resourcesmentioning

confidence: 99%

Dementia Care in Canada: Nursing Recommendations

2019

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RÉSUMÉAu Canada, la prévention et la prise en charge des démences ont atteint un point tournant. Bien que le taux de diagnostic des démences soit encore bas, le nombre de personnes qui en sont atteintes continue d’augmenter. Les politiques canadiennes en matière de soins de santé ont fait en sorte qu’un plus grand nombre de personnes avec démence vivent à la maison, où les soins sont principalement assurés par la famille, des amis ou des proches. Cette Note de politique présente un aperçu d’un document conjoint de l’Association canadienne des infirmières et infirmiers en gérontologie (AIIG) et de l’Association des infirmières et infirmiers autorisés de l’Ontario (AIIAO) devant le Comité sénatorial permanent des affaires sociales, des sciences et de la technologie. Le document expose le cadre contextuel et les recommandations pour les soins liés à la démence au Canada dans cinq domaines clés : les ressources du système de santé, la formation des prestataires de soins de santé, le logement, les partenaires de soins et l’intégration des soutiens offerts en services sociaux et de santé. Dans le cadre de ces cinq domaines clés, des interventions en matière de santé et de politiques sociales ont été examinées.

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Section: Health System Resourcesmentioning

confidence: 99%

Dementia Care in Canada: Nursing Recommendations

2019

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“…Pilot testing of the revised screening protocolwith consideration for feasibility, acceptability to health care providers and patients, and efficiencywill further support improvements to this program. Of particular interest will be evaluative studies of the impact of C5-75 in enabling primary care to better identify and manage older adults living with frailty and streamlining referrals to geriatric medicine specialists, similar to other programs that build capacity in primary care for the management of complex geriatric conditions and improve efficiency of use of limited available specialist resources (Lee et al, 2010;Lee et al, 2018c).…”

Section: Limitations and Future Researchmentioning

confidence: 99%

The C5-75 Program: Meeting the Need for Efficient, Pragmatic Frailty Screening and Management in Primary Care

et al. 2020

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Case-Finding for Complex Chronic Conditions in Seniors 75+ (C5-75) is a systematic approach to identify frailty using gait speed and hand-grip strength and to screen for co-morbid conditions. We identified the C5-75 features offering the highest yield for identifying frailty and to streamline the screening program. Analyses included 1,948 C5-75 assessments completed from 2013 to 2018. Age 85 or older, less than regular physical activity, and more than two falls in the previous six months had the strongest associations with frailty. Exempting patients under 85 who reported regular physical activity and less than two falls excluded 39.1 per cent of the cohort while maintaining a sensitivity of 95.2 per cent and a negative predictive value of 99.4 per cent for frailty. These findings provide insight into optimizing screening for frailty, making it more feasible to implement and to identify co-existing conditions that may contribute to or be affected by frailty.

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“…PCCMCs facilitate earlier diagnosis; typical wait times of 1.5 months for assessment in PCCMCs (Lee, Hillier, Molnar, et al, ) are in contrast to the 6–12 month wait for assessment by some specialists (Massoud, Lysy, & Bergman, ). By managing the majority of memory concerns in primary care, with use of limited specialist resources reserved for more complex and urgent cases, overall average wait times for specialist consultation have also decreased by up to 47% over a 1‐year time period (Lee, Hillier, et al, ). PCCMCs have demonstrated positive patient and care partner and referring physician experience, with improved access to assessment and management of memory concerns, reduced wait times for care, and increased access to community and home care services (Lee & Hillier, ; Lee, Hillier, & Harvey, ; Lee, Hillier, Heckman, et al, ; Lee, Lu, Hillier, Gregg, & Kaufman Carlin, ; Lee et al, ).…”

Section: Introductionmentioning

confidence: 99%

Partnerships for improving dementia care in primary care: Extending access to primary care‐based memory clinics in Ontario, Canada

Lee

Hillier

Gregg

2019

Health Soc Care Community

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In Ontario, Canada, the Primary Care Collaborative Memory Clinic (PCCMC) model of dementia care provides a team‐based assessment and management service that has demonstrated increased capacity for dementia care at the primary care level. PCCMCs are established following completion of a multi‐faceted memory clinic training programme. Evidence of the success of this care model has been demonstrated primarily in practice settings with integrated interprofessional healthcare providers (HCPs). Desire to implement PCCMCs in less‐resourced family practice settings without integrated interprofessional HCPs has resulted in partnerships with community agencies and services to create the multifaceted teams needed for this care model. The purpose of this study was to describe the key lessons learned in the development and implementation of 18 PCCMCs in primary care practice models without integrated interprofessional HCPs. Mixed methods included tracking of clinic referrals, pre‐ (N = 122) and post‐ (N = 71) training surveys to assess practice changes and factors facilitating and challenging clinic implementation. Interviews were conducted with 40 team members to identify key lessons learned. Key enablers were access to training, organisational/ management and care provider support, availability of infrastructure supports and clinic coordination. Data were collected between January 2012 and January 2017. PCCMCs were challenged by a lack of sustainable funding, inadequate infrastructure support, competing priorities, maintaining adequate communication among team members, and coordinating multiple schedules. Suggestions to support longer term sustainability were identified, many addressing identified challenges such as securing sustainable funding, and ensuring partners understand the importance of their role and succession planning. This study demonstrated that by establishing community partnerships and leveraging existing community resources, the PCCMC model is generalisable to multiple family practice settings including those without integrated interprofessional staff. Lessons learned can inform the development of interventions for complex chronic conditions requiring interprofessional support in primary care.

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Effect of Primary Care‐Based Memory Clinics on Referrals to and Wait‐Time for Specialized Geriatric Services

Cited by 12 publications

References 7 publications

Dementia Care in Canada: Nursing Recommendations

Dementia Care in Canada: Nursing Recommendations

The C5-75 Program: Meeting the Need for Efficient, Pragmatic Frailty Screening and Management in Primary Care

Partnerships for improving dementia care in primary care: Extending access to primary care‐based memory clinics in Ontario, Canada

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