RaDAR’s focus on primary health care emerged from stakeholder feedback and experiences in the Rural and Remote Memory Clinic, which highlighted the challenges of diagnosis and management from the perspectives of patients, families, and health care providers.
The rural primary health care (PHC) memory clinics evolved through a collaboration with the former Sun Country Health Region on a 5-year research intervention program (2014-2019) as part of Phase 1 of the Canadian Consortium on Neurodegeneration in Aging.
Our goal was to implement an effective and sustainable model of dementia care in rural communities that integrated interprofessional care, remote specialist-to-provider support, and decision support tools. Partnering with the Kipling PHC team in 2015, we implemented the initial model using a 5-step approach (Morgan et al., 2019).
- Interprofessional care - multiple PHC team members and the Alzheimer Society First Link Coordinator are involved in the 1-day clinics, providing timely diagnosis, management, and support
- Remote specialist-to-provider support - RRMC specialists Dr. Andrew Kirk and Dr. Megan O’Connell offer ongoing mentoring and education sessions to teams
- Decision support tools – flow sheets were adapted from the Primary Care Assessment and Treatment Algorithm (PC-DATATM) and added to the teams’ EMR system. PC-DATATM is based on Canadian consensus guidelines and was developed by geriatric psychiatrist Dr. Dallas Seitz. The Kipling team also created a handbook that includes scripts for discussing sensitive topics.
Rural Primary Health Care (PHC) Memory Clinics
Three PHC teams in southeast Saskatchewan offer 1-day memory clinics - Kipling, Weyburn, and Rural West. Clinics are held every second month or as needed. Spreading the memory clinics to other rural communities is a priority for the RaDAR team.
Download a brochure about the memory clinics.
Chelsie Cameron supports the use of best practices across the PHC memory clinics and assists with spreading the memory clinic model to primary health care teams in rural Saskatchewan.
Related Research Projects
RaDAR Memory Clinics: Evaluation of Sustainability, Spread, and Community Programs Providing Post-diagnostic Services
Project 1. Process Evaluation of Sustainability and Spread of RaDAR Memory Clinics
- To examine the sustainability and spread of the RaDAR memory clinics, guided by the Consolidated Framework for Implementation Research (Damschroder et al. 2009). Contextual factors will be analysed at the level of innovation, individual, inner setting, outer setting, and process.
Project 2. Co-development and Evaluation of Action Plans to Sustain and Spread RaDAR Memory Clinics
- To co-design and evaluate action plans to sustain current memory clinics and spread the clinics to other primary health care teams across rural Saskatchewan.
Project 3. Environmental Scan of Community Programs Providing Post-Diagnostic Services to RaDAR Memory Clinic Patients and Families
- To identify the post-diagnostic programs available in the communities of rural PHC memory clinic patients, and to explore patient and family needs, characteristics of the programs and program providers, program gaps and innovations, and recommendations to address program gaps. We will create inventories and maps of community programs to track changes over time in the availability of post-diagnostic services in the communities rural PHC memory clinics.
Project 4. Formative Evaluations of Community Programs Implemented or Adapted to Provide Post-Diagnostic Services to RaDAR Memory Clinic Patients and Families
- To examine whether programs are reaching intended clients, achieving promising short-term outcomes, and have the resources necessary to effectively operate; and to determine whether short-term outcomes are meeting expectations, allowing an opportunity to modify programs before implementing fully and spreading to other rural communities.
Project 5. Rural Memory Clinic Team Members’ Perceptions of Education Sessions
- To conduct an ongoing evaluation of dementia-related education sessions offered in relation to the rural PHC memory clinics, examining the needs of participants that emerge in the sessions and participants’ perceptions of the sessions.
Memory assessment and diagnosis within a team-based rural primary health care model: patient and family perspectives (led by Dr. Melanie Bayly)
- To investigate the experiences of patients and families who are assessed for dementia by the rural PHC memory clinic teams. This will allow us to better understand patient and family perceptions of a collaborative team-based model of dementia care, their needs and whether they are being met, and how the assessment processes could be improved.
Benefits and challenges of the Alzheimer Society First Link Coordinator role in rural primary health care memory clinics (led by Dr. Melanie Bayly)
- To explore potential differences based on referral method (self-referral, referral by care provider, or initial memory clinic visit), in the timing, number, and content of client contacts with First Link; to understand the challenges and benefits of First Link’s involvement with the memory clinics from the perspective of participating First Link coordinators and other members of the rural memory clinic teams.
Evaluation and management of patients in interprofessional rural primary health care memory clinics: a chart review and data linkage study
- To examine the demographic and clinical characteristics of patients evaluated and managed in rural PHC memory clinics; identify the types of recommendations and referrals made by the teams; compare patient evaluation and management by the teams to recommended guidelines; and examine whether rural PHC memory clinics are associated with earlier dementia recognition or diagnosis
Care Partner Outcomes After Family Member Evaluation in Interprofessional Rural Primary Health Care Memory Clinics
- To evaluate the effect of care partner involvement in rural PHC memory clinics on outcomes for care partners, including community service uptake and barriers, information needs, distress, experience of crisis situations, and self-efficacy
Interprofessional Rural Primary Health Care Memory Clinics: A Multiple Case Observational Study
- At the time of initial patient evaluation rural PHC memory clinics, to explore clinical practices in decision-making regarding diagnosis and treatment, care plans, and recommendations to patients and families; communication patterns within clinic team, and between the team and patient/family; information utilization and sharing routines within the teams, and between the team and family; and the influence of the built environment and team co-location on communication, and information utilization and sharing team member roles and negotiation of role overlap
Understanding how rural primary health care teams collaborate to deliver dementia care (led by Dr. Amanda Froehlich Chow)
- The primary purpose of this study is to understand how rural primary health care (PHC) teams are currently collaborating to deliver care to older adults living with dementia and other chronic conditions.
Podcast introduction to the Kipling Memory Clinic, featuring the story of Leanne and her mother Marjory, supported by Jean Daku, Kipling Nurse Practitioner. Dementia Dialogue System Journey Podcast Series. Transitions- A Rural Dementia Resource for rural communities. Sept 28, 2020.
Analysis & Policy Observatory Guest blog by Dr. Debra Morgan, RaDAR Lead. Rural Dementia in Action by Debra Morgan. August 16, 2020.
Reflection article by Jennifer Hill, Primary Health Care Facilitator with the Weyburn Memory Clinic Team. Embracing Research in Rural Dementia Care. December 18, 2019.
Story about Rural PHC Memory Clinics in SaskHealth (page 13), Saskatchewan Health Authority's annual report to the community. Dementia care program provides care closer to home (15 MB). December 2, 2019.
Interview of Dr. Debra Morgan by Drew Wilson, CJWW Radio. Bringing Dementia Care into Rural Saskatchewan. September 19, 2019.
Backgrounder on Rural PHC Memory Clinic model on Saskatchewan Health Authority website. RaDAR – The Rural Dementia Action Research Team. September 12, 2019.
SHRF support of Rural PHC Memory Clinics on Saskatchewan Health Research Foundation website. Building Capacity for Rural and Remote Dementia Care. September 12, 2019.
Profile of Rural PHC Memory Clinics on Saskatchewan Health Authority website. RaDAR: Dementia care close to home. August 8, 2019.
Publications & Reports
Rural PHC Memory Clinics: 2020 Report (0.5 mb). Saskatoon, Saskatchewan: University of Saskatchewan.
Rural PHC Memory Clinics: Fall 2019 (4 mb). Saskatoon, Saskatchewan: University of Saskatchewan.
Morgan et al. 2019. Barriers and Facilitators to Development and Implementation of a Rural Primary Health Care Intervention for Dementia: A Process Evaluation. BMC Health Services Research, 19:709. doi:10.1186/s12913-019-4548-5
Morgan et al. 2019. A 5-step approach for developing and implementing a rural primary health care model for dementia: A community-academic partnership. Primary Health Care Research & Development, 20 (e29). doi:10.1017/S1463423618000968
For more information about the clinics:
Dr. Debra Morgan 306-966-7905