[Editor’s note: Tyee contributing editor Crawford Kilian is spending 2019 exploring dementia and brain health.]
One of the real challenges for families dealing with a new diagnosis of dementia is finding timely expert advice. Few family physicians have extensive experience in the field, and referrals to experts may involve long waiting times. For those living in small towns and rural districts, long trips may also be needed.
This puts an additional burden on caregivers, who may also be holding down a job or raising children, or both. The resulting stress only adds to the burden; meanwhile, the condition of the loved one with dementia may be worsening, and the pressure to move the loved one to a care facility may be irresistible.
An Ontario GP, Dr. Linda Lee, has found a way to deliver expert advice and support through local “memory clinics.” Her methods have earned her several professional awards, and now she and her colleagues are poised to establish memory clinics nationwide.
To learn more about Dr. Lee and her concept, The Tyee interviewed her by email (edited for length and clarity).
The Tyee: Can you provide a little background on your professional experience with persons with dementia?
Dr. Lee: I am a Care of the Elderly family physician at the Centre for Family Medicine Family Health Team and a Schlegel Research Chair in Primary Care for Elders. I have spent the past 30 years practicing family medicine in Kitchener-Waterloo, Ontario, and caring for older adults living with dementia and in long-term care.
Together with my team, I developed the MINT Memory Clinic model, a fresh approach to timely, complete and compassionate memory care within primary care settings. As part of this model, I also developed a nationally accredited dementia care training program, which has enabled 114 other primary care settings in Ontario to establish MINT Memory Clinics.
In 2019, I was awarded a Joule Innovation Grant to increase collaborative partnerships between MINT Memory Clinics and specialists and to support adaptation of the MINT Memory Clinic model to suit primary care settings in other provinces in preparation for national spread.
When did you realize families with dementia needed more immediate, local care?
Early in my career, I recognized a gap in care for persons living with dementia and other memory problems, especially those living in rural and remote communities. Patients and caregivers continued to tell me that dementia care was difficult to access, felt fragmented and was tough to navigate. In recent years, these challenges have been made more difficult by increasingly crowded hospitals and long-term care homes in Ontario, and I know this is a challenge in other provinces as well.
Dementia is also an increasing health issue. Today, more than 560,000 Canadians live with dementia and by 2030, that number is expected to reach nearly one million. Evidence shows that delays in dementia diagnosis and intervention lead to worse health outcomes for both patients and caregivers. With an already-strained health-care system and fewer than 300 dementia care specialists across Canada, we aren’t prepared to meet their needs.
Together with my team and other collaborators, we wanted to fill this gap in care by developing a new model that would build capacity in primary care, make the most out of our limited resources and better serve the growing number of families that need access to high-quality dementia care.
How did you go about developing the first memory clinic?
Our first memory clinic was developed at our site in Kitchener. As front-line clinicians in primary care, we were very aware of the gaps in care for persons living with dementia and family members, and we tried to address these as a team using evidence-based research and best clinical practices.
Using our skills in family medicine, social work, nursing and pharmacy, we collaborated to create a model that was efficient and practical in the primary care setting, maximized information sharing, and built on each others’ expertise.
Most of all, we relied on feedback from patients and caregivers to help shape and refine our clinic processes, ensuring the services we offered truly met the needs of persons living with dementia.
What were key lessons you and your colleagues learned in the early years?
The importance of true interprofessional collaborative practice, where effective communication within the team and shared knowledge and skills of the various disciplines are synergistic. Working together, team members can offer complete, person-centred care that is accessible in one location, close to home, typically within the family doctor’s office.
Persons living with dementia and their families found it incredibly valuable to be able to access all of their care needs from one location from a team of skilled health-care providers whom they trust and whom they can turn to in times of need.
When did MINT Memory Clinics emerge as an organization? How was the organization funded?
Our Clinics were formerly called Primary Care Collaborative Memory Clinics, but we changed the name to MINT Memory Clinics around a year ago to reflect the Multi-specialty INterprofessional Team, which is at the core of the model. Our flagship clinic was developed at our site in 2006 within the Centre for Family Medicine’s Family Health Team in Kitchener. We began training MINT Clinics in 2008 at the encouragement of the Ontario College of Family Physicians to spread the model to other family practice sites.
We are not for profit, and we have been funded via grants from various organizations such as the Ontario Brain Institute, Alzheimer Society of Ontario, Health Quality Ontario/Council of Academic Hospitals of Ontario, the Ontario College of Family Physicians, and the Ontario Ministry of Health and Long-Term Care.
How did you recruit new people to staff memory clinics?
Most of the MINT Memory Clinics we’ve trained actually approached us to request training — they had heard about the program and wanted to implement the model within their own communities. In some cases, regional health organizations themselves identified communities most in need of improved access to dementia care and encouraged sites to participate in our training program.
MINT clinics also collaborate closely with specialists in geriatric medicine, geriatric psychiatry, and cognitive neurology through virtual consultation. Specialists benefit from the partnership in several ways. It helps to improve capacity and reach, especially to rural and remote communities, and it helps to increase efficiency and impact. As the MINT model expands, so does our valued network of specialists who partner with local clinics.
Given the clinics’ evident success in Ontario, could they be adopted in other provinces?
The ultimate goal of MINT Memory Clinics is to enable all Canadians living with dementia to maintain well-being and community living with the best quality of life for as long possible.
Our impact in Ontario demonstrates that this innovative solution is highly valuable for patients, health-care providers and Canada’s health-care system. The model is highly scalable, with a 90 per cent adoption rate following the MINT training program, and it is now ready for spread to other provinces.
We feel strongly that the MINT Memory Clinic model can be adapted to suit other Canadian provinces and the unique primary care and specialist care service delivery models within those jurisdictions.
We have developed a nationally accredited training program, designed to build capacity and empower health-care workers to establish MINT clinics in their own primary care settings.
We are confident that, with the right support and resources, our primary care-based model could spread successfully on a national scale, in all kinds of settings.
What, in your view, is the aspect of the memory clinics that’s least well reported in the media?
This innovative model is a solution that can have a significant impact on the quality of life for persons living with dementia and their families, while also relieving the pressure on our strained health-care system. And this is demonstrated in a recent independent evaluation of the clinics, commissioned by the Ontario Ministry of Health and Long-Term Care.
What did the independent evaluation find?
By collaborating with specialists and building capacity within primary care, the clinics significantly improve access to high-quality dementia care and support.
Ninety per cent of persons living with dementia can have all of their care needs met within primary care in the MINT Memory Care model.
Only 10 per cent of patients in MINT Memory Clinics are referred to specialists, compared to more than 100 per cent of patients in non-MINT Memory Clinics (sometimes patients are referred to multiple specialists).
This unique partnership enables patients and caregivers to receive dementia screening and early intervention nearly 50 per cent sooner than they would in the typical model of care.
Improved access to proactive, ongoing dementia care within the community also helps persons living with dementia stay at home longer, which is great for patients and families and helps to reduce current pressures on our health-care system.
The evaluation showed that hospitalizations for MINT clinic patients occurred later and were shorter, with fewer ALC days [alternate level of care days, when patients remain in a hospital acute care bed after the acute phase of their treatment] and more patients being discharged home.
It also showed that first visits to the emergency department occurred later, with fewer admissions. This amounted to a 50 per cent reduction in costs for hospitalization and emergency room visits
Patients receiving care in MINT Memory Clinics were also shown to delay the transition into long-term care by an average of six months compared to patients receiving care outside of this model
All of this translates to significant savings for the health-care system. The evaluation showed a 38 per cent reduction in cost per day throughout a patient’s dementia care journey, including hospital visits, specialty care, home care and long-term care.
It also showed a 55 per cent reduction in inpatient hospital costs, including ALC days, a 50 per cent reduction in emergency department visit costs, 46 per cent reduction in physician fee for service costs, and a 20 per cent reduction in long-term care costs.
Our model supports health-care providers by building capacity and integrating resources, and it makes dementia care easier to access and navigate for patients and families. Ninety-six per cent of patients and caregivers would recommend the clinics to others.
We were thrilled to have this comprehensive evaluation commissioned by the Government of Ontario because the findings really demonstrated what we anticipated all along — that this model of care uses our existing assets to deliver more and better care for patients and caregivers, at lower health-care system costs.
We know we need more innovative, integrated health-care solutions to improve the delivery of dementia care, and we have one in the MINT Memory Clinics.
This series is made possible by a grant from Bruce and Gail Macdonald.
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