Centre for Family Medicine, Family Health Team, Kitchener, Ontario, Canada.
J Am Geriatr Soc. 2010 Nov;58(11):2197-204. doi: 10.1111/j.1532-5415.2010.03130.x. Epub 2010 Oct 26.
Memory clinics have been promoted as opportunities for improving dementia diagnosis and care. This article describes the implementation of an interdisciplinary memory clinic within primary care in Ontario, Canada, that aims to provide timely access to comprehensive assessment and care and to improve referring physicians' knowledge of the management of dementia through collaborative care and practice-based mentorship. Between July 2006 and September 2009, 246 initial and follow-up assessments were conducted with 151 patients, a high proportion of whom received a new diagnosis of mild cognitive impairment (44.4%) or dementia (19.2%). A trial of cholinesterase inhibitors was recommended for almost all patients newly diagnosed with dementia. Management interventions and recommendations included social worker outreach, long-term care planning, home safety or driving assessments, referral to community resources, and periodic follow-up and monitoring. A small proportion of patients (7.8%) were referred to a specialist. Surveyed patients and caregivers were very satisfied with their visit to the clinic. A chart audit conducted by two independent geriatricians indicated agreement with diagnosis and intervention, particularly related to use of specialists. The results indicate that memory clinics within primary care settings can support capacity building to ensure quality assessment and management of dementia at a primary care level.
记忆诊所被宣传为改善痴呆症诊断和护理的机会。本文描述了在加拿大安大略省的初级保健中实施跨学科记忆诊所的情况，该诊所旨在通过协作式护理和基于实践的指导，为患者提供及时的全面评估和护理，并提高转诊医生对痴呆症管理的认识。在 2006 年 7 月至 2009 年 9 月期间，对 151 名患者进行了 246 次初始和随访评估，其中很大一部分患者被新诊断为轻度认知障碍（44.4%）或痴呆症（19.2%）。几乎所有新诊断为痴呆症的患者都被建议试用胆碱酯酶抑制剂。管理干预和建议包括社工外展、长期护理计划、家庭安全或驾驶评估、向社区资源转介以及定期随访和监测。一小部分患者（7.8%）被转介给专家。接受调查的患者和护理人员对他们在诊所的就诊非常满意。两名独立老年病医生进行的图表审核表明，诊断和干预的一致性，特别是与使用专家相关。结果表明，初级保健环境中的记忆诊所可以支持能力建设，以确保在初级保健层面进行高质量的痴呆症评估和管理。
