A win-win-win: How a novel integrated approach is disrupting dementia care

September 24, 2019 Kerrie Whitehurst

Nearly one million Canadians will live with dementia by 2030.

A 2015 study shows that Canadian physicians are feeling less prepared to manage care in the community for seniors living with dementia, and the number of geriatricians is decreasing each year.

It’s clear that Canada’s already-strained system isn’t prepared to meet the complex needs of dementia patients and their caregivers.

Enter MINT―Multi-specialty iNterprofessional Team-based Memory Clinics―an innovative approach changing the way care is delivered to patients with dementia.

 

“We can do better”

The MINT model is the brainchild of Dr. Linda Lee, a family physician with more than 30 years in practice. Dr. Lee first developed a primary-care memory care clinic in 2005 within the Centre for Family Medicine Family Health Team in Kitchener, Ontario.

The inspiration fueling the model came from Dr. Lee’s professional and personal experience. “I realized, in the regular system of practice, that distinguishing between cognitive aging and cognitive impairment and dementia is tough to do,” said Dr. Lee. “Most importantly, it impacts the amount of suffering that a person with memory loss and their families experience. So early in my career, I decided that would be something we could do better.”

 

How it works

MINT clinics are based in primary care settings and led by trained family physicians. It’s an integrated model of care that includes nurses, social workers, occupational therapists, pharmacists, the Alzheimer Society, and others as available.  

Together with their MINT team, patients and caregivers engage in a virtual online consult with geriatric specialists. The consult acts as a triage and a diagnosis is made early in the process.

In most cases, the primary care providers end up managing dementia cases in the community. Referrals are streamlined―only those patients who truly need to see a geriatric specialist are referred to one.  

Compared to a typical practice where almost all would be referred, just 9% of MINT’s patients are referred to specialists.

It’s a timely, evidence-based, complete, compassionate and―dare we say―person-centred approach to memory care.

 

A win for primary care

A major “win” with the MINT model is its focus on interprofessional teamwork. “It is a truly integrated approach, and not about a single person,” said Dr. Lee. “Teams get better and better, learning from each other and increasing expertise. It’s about learning to trust.”

For primary care providers, this approach brings a host of positive impacts.

  • Increased collaboration with colleagues, patients and caregivers;
  • Improved communication with specialists;
  • Continuous, contextual learning;
  • Ongoing mentorship and support in decision making;
  • Satisfaction in working to full scope of professional practice.

One participating primary care physician said working with specialists within the collaborative model “provides reassurance that our assumptions are good. Reinforces (our) plan. Helps guide us when we are stuck.”

 

A win for specialists

The results of ongoing evaluations show that specialists, too, are gaining professional rewards. 

  • Positive collaboration and direct interaction with primary care providers;
  • Comprehensive assessment results from physicians, with good baseline information;
  • Memory clinics managing less complicated cases independently;
  • Feeling included in the memory clinic team;
  • Learning from family physicians.

“I like learning from their perspective,” said one participating specialist. “They challenge me to be more efficient, and (I) help them to become more efficient… I think that there has been a greater understanding by me of what I can offer in primary care, and vice versa.”

 

A win for patients

The benefits for patients are equally compelling.

  • Shorter wait times―patients have quick and easy access to specialist care;
  • Earlier detection of dementia—interventions can begin sooner;
  • Care provided in a familiar environment and close to home―a bonus for those in rural or remote communities;
  • Improved continuity and coordination of care within the community.

“Working in a team, we seem to have better access and understanding about resources available and good partnerships have been established,” said one patient of their experience with the MINT model.

 

Potential for spread

MINT memory clinics are now successfully operating in 112 communities across Ontario, in urban and rural settings alike. You can find them in physicians’ offices, community health centres and hospitals.

Dr. Lee has also 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.

Consistency in training means that clinics can flourish in complementary settings too, such as retirement residences and long-term care homes.

There is no doubt that, with the right support and resources, this primary care-based model could spread successfully on a national scale, in all kinds of settings.

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This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about physician-led innovation? Please connect with us at jouleinquiries@cma.ca.

About the author

Kerrie Whitehurst

Kerrie Whitehurst is an Ottawa-based writer and editor with a passion for clear language. She has worked with prominent Canadian healthcare organizations for more than 20 years, specializing in exploring complex issues, finding stories that resonate, and producing easy-to-read content for all audiences. Kerrie has also worked in strategic communications, media, publishing, and marketing.

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