Evaluating the Implementation of Three Integrated Care Programs for Older Adults with Major Neurocognitive Disorders

Abstract

Federal and provincial governments in Canada have mobilized resources to address the challenges of care associated with the growing population of older adults with major neurocognitive disorders (MND), which include Alzheimer's and other related diseases. Researchers and practitioners in Québec, Ontario, and Saskatchewan identified a need for better integrated care for older adults with MND, improved capacity for assessment, diagnosis, and management of cases, as well as greater accessibility for those living in rural and remote regions. To this end, three distinct programs---the Réseau de services intégrés pour personnes âgées en perte d'autonomie cognitive (RSI-PAPAC) in Québec, the Primary Care Collaborative Memory Clinic (PCCMC) in Ontario, and the Rural and Remote Memory Clinic (RRMC) in Saskatchewan---were developed with the help of funding from provincial governments and federal research grants. The objective of this article is to compare and analyze the implementation and performance of these programs. Each program saw a large scope of services offered with the integration of community services and a great degree of coordination between these actors. The RSI-PAPAC was a roster program implemented in a collection of community health centres in Québec, while the latter two were clinical models that originated out of one central clinic. In Québec, while the specific program we analyzed is no longer active today, the ministry of health and social services has since adopted a comprehensive action plan rolling out services at a provincial scale (unrelated to the program we analyzed). In Ontario, with the help of interested organizations, the PCCMC has since been scaled up across the province, with over 100 clinics now active. It was easily adopted due to the quick training program offered to physicians and its reliance on patients' existing circle of care. Finally, in Saskatchewan, the RRMC has not scaled up to other clinics, likely due to the lack of existing collaborative primary clinics such as those in Ontario; however, provincial governments and other health organizations have mobilized to fund its continuation, and it currently operates out of one clinic in Saskatoon, serving as a node of care and research within the University of Saskatchewan.

Keywords

• dementia
• alzheimer
• older adults
• primary care
• integrated care
• memory clinics