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With COVID-19 highlighting the substantive risks to older adults living in congregated settings, an emphasis should be on supporting persons with dementia to live in the community safely for as long as possible. Primary care-based interventions such as Multispecialty Interprofessional Team (MINT) memory clinics (previously referred to as Primary Care Collaborative Clinics) provide a significant opportunity to support community-dwelling older adults to live at home, delay long-term care placement, and address systemic challenges that impede the delivery of quality dementia care.
Although primary care is well positioned to manage chronic disease, family physicians lack the knowledge and confidence to adequately assess and manage dementia and, as a result, the condition often goes undiagnosed and unmanaged with resulting deleterious consequences for patients and families.
Moreover, the structure of family practice does not allow enough time to manage the complex issues associated with this condition and many family practices lack the resources needed to optimally manage dementia.
Support for community-dwelling persons with dementia is further hampered by a lack of integration and coordination between health services and providers, and poor information sharing and transitions between health sectors.
MINT memory clinics aim to build primary care capacity for comprehensive dementia assessment and management, increase efficiency of referrals to specialists, extend reach of their expertise to rural and remote communities through collaboration with MINT clinics, and increase equitability of access to timely, necessary dementia care.
The MINT memory clinic care model is characterized by 4 major components, as presented in Supplementary Figure 1.
MINT memory clinics are family physician-led and include nurses, social workers, pharmacists, occupational therapists, and other disciplines. Inclusion of representatives from various community agencies and services as available provides timely and ongoing access to community supports. Each team is supported by a triad of specialists in geriatric medicine, geriatric psychiatry, and cognitive neurology, who provide consultation support to team members for more complex cases using virtual technologies and, when needed, direct patient consultation. Assessments include standardized, evidence-informed assessments of cognition, mood, functional ability, caregiver burden, and medications; assessments include both patients and their caregiver.
Comprehensive care plans are customized to preferences, goals, and needs of each patient-caregiver dyad. These care plans, along with support from the interprofessional team, serve to enhance the capacity of referring family physicians to provide better dementia care within this shared care approach. Continuing care is provided over the course of the illness with pro-active, rather than reactive, assessment and management of safety risks, aiming to avert crises that lead to hospital admissions and early institutionalization.
As most clinics operate in the patient's own primary care setting, care is accessible close to home and delivered by familiar care providers. MINT clinics are established following a standardized, evidence-informed, and nationally accredited training program that is completed by all team members.
Annual Booster Days provide ongoing knowledge and skill development and serve to facilitate development of regional and provincial Communities of Practice.
Multiple evaluative studies have demonstrated that the memory clinic training program and the MINT memory clinics have increased capacity for high quality dementia care in primary care.
These findings have been supported by the results of an independent third party evaluation commissioned by the Ontario government, which found that MINT clinics are associated with significant cost savings for Ontario's healthcare system with lower emergency department and hospitalization costs, delayed admissions to long-term care by nearly 6 months, and substantive reduction in referrals to specialists compared with usual care.
Several studies have also demonstrated positive patient, caregiver, and referring physician experience with the care provided by the clinics, as well as increased access to community and home care services to further support community living.
The MINT memory clinic team approach to care provides continuing, comprehensive person-centered care, with an efficient, collaborative care process and training and skills-building opportunities for team members. With increased capacity for high quality dementia care in primary care and efficient collaboration and integration with specialist care, persons with dementia are enabled to live at home as long as possible, thereby delaying transition into long-term care. Moreover, potential exists for significant health system cost savings and reducing current pressures on hospitals and long-term care.
Supplementary Data
Supplementary Fig. 1Mint memory clinics: Core components and implementation details.
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