Family-Practice-Based Memory Clinics — How They Work

Dr. Linda Lee runs Centre for Family Medicine in Kitchener, Ont., and is developing a model of family-practice-based memory clinic that will allow patients to access the care they need without a referral to a specialist. It’s a model that will not only save the public health system money, but one that will give patients and their families quicker access to what they need. (Read how the memory clinic helped one family here.)

Her clinic structure includes a family doctor who is backed by a specialist, but that specialist doesn’t see patients — they offer advice to the family doctor. Other members of the team (nurses, social workers, pharmacists, etc.) provide services directly to the patient.

“To the best of our knowledge, this model doesn’t exist anywhere else,” says Lee. Even in Europe, which is generally more advanced in dementia care than North America, memory clinics are led by specialists. “This is the first model that allows primary care to build capacity to do more than they could have done before.

“The goal of the clinic is comprehensive care that allows people to live in their own homes independently for as long as possible, to avert hospital visits and maintain the best quality of life for as long as they can. That is our aim,” says Lee. By the end of 2014, she will have trained family doctors in 63 memory clinics across Ontario.

A visit to her clinic, or one run by those she trained, begins with a diagnosis. “We have specially trained 110 family physicians so they will be able to make a diagnosis accurately, given that it’s a very challenging diagnosis to make early on,” says Lee.

Sharon Dillon-Martin is the clinic social worker and often the next step for patients. “We sit down to talk about future planning,” she says. “Where are you going to live, do you have a power of attorney, what community services do you need?” The staff occupational therapist can go do home visits and conduct an abilities assessment, which can be used to secure services through the local CCAC.

Lee’s clinic started in 2006 and her five-day Memory Clinic Training Progam, offered in collaboration with the Ontario College of Family Physicians and operating on a not-for-profit basis, started in 2008. “Dementia has largely been a specialist-managed condition,” says Lee. “With this training, we’ve been able to move much of dementia care into the primary care level in a way that provides greater access.”

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Jasmine Miller

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