2 out of 5 Canadian doctors feel well-prepared to manage community dementia care
The growing number of seniors living with dementiaReference1 is leaving some primary care doctors feeling less well-prepared to manage dementia care in the community.
The results of the 2015 Commonwealth Fund Survey of Family Physicians show that more than 86% of Canadian primary care doctors “often” or “sometimes” provided medical care for people living with dementia, but just 41% of all surveyed doctors felt they were well-prepared to manage this care. In comparison, 69% of surveyed doctors in Norway and 63% in the U.K. felt well-prepared, while The Commonwealth Fund average was 52%.Reference2
Doctors are more comfortable at the initial assessment and appropriate baseline testing for dementia but face more difficulties when the disease becomes more advanced and difficult for caregivers to manage.— Dr. Nicholas Pimlott
“At that stage, the care becomes more time-consuming and labour-intensive — not only are you providing medical care, but you’re also helping and caring for the family. But if you could do it, and do it well, it makes a huge difference for patients and their families,” said Dr. Nicholas Pimlott, a clinical researcher and physician at the Family Practice Health Centre at Women’s College Hospital in Toronto and an associate professor in the Department of Family and Community Medicine at the University of Toronto.
The doctors who were surveyed in countries that have national dementia strategies felt most prepared to manage care for seniors living with dementia. On June 22, 2017, Canada became the 30th country in the world to pass a bill mandating a national dementia strategy,Reference3Reference4 in response to the increasing population age 65 and older and the related public health challenges. Notably, dementia strategies were already in place at the provincial level in some jurisdictions: Nova Scotia, Quebec, Ontario, Manitoba, Alberta and British Columbia.Reference4Reference5
Ideally, family doctors are the cornerstone of the support network for people living with dementia by facilitating early diagnosis and treatment, and by helping to manage behaviours, wandering, and falls or other injuries. They help connect seniors living with dementia with timely community and medical support, and they facilitate the transition between care settings as the stages of the disease progress.
Challenges in dementia care and potential reasons family doctors feel ill-prepared, according to studies in Canadian Family Physician,Reference6Reference7 include the complexity of dementia, difficulties diagnosing dementia, lack of access to specialists (particularly in rural and remote areas), insufficient knowledge of community-based resources, time constraints and challenges coordinating patients’ and families’ needs.
“Reduction in home visits is another potential factor for the discomfort in providing care,” said Dr. Pimlott. “Too much care is centred in the office-based practice — and in late-stage dementia, office-based practice is not the best.”
Family doctors’ preparedness to manage community dementia care
In 2015, 41% of Canadian primary care doctors felt they were well-prepared to manage dementia care in the community. In comparison, 69% of doctors in Norway and 63% in the U.K. felt well-prepared, while The Commonwealth Fund average was 52%.
Canadian Institute for Health Information. How Canada Compares: Results From The Commonwealth Fund 2015 International Health Policy Survey of Primary Care Physicians — Data Tables. 2016.
Similarly, the Canadian Home Care Association found that 78% of home care providers reported a “high” or “very high” degree of challenge providing care in the home for people living with dementia.Reference8
Examples of programs and initiatives supporting primary health care
- Back to reference 1 in text
- Standing Senate Committee on Social Affairs, Science and Technology. Dementia in Canada: A National Strategy for Dementia-Friendly Communities External link, opens in new window. 2016.
- Back to reference 2 in text
- Canadian Institute for Health Information. How Canada Compares: Results From The Commonwealth Fund 2015 International Health Policy Survey of Primary Care Physicians — Data Tables. 2016.
- Back to reference 3 in text
- Parliament of Canada. An Act respecting a national strategy for Alzheimer’s disease and other dementias External link, opens in new window. June 22, 2017.
- Back to reference 4 in text
- Alzheimer Society of Canada. Canada’s national dementia strategy External link, opens in new window. Accessed February 13, 2018.
- Back to reference 5 in text
- Wilson MG, Mattison CA, Waddell K. Rapid Synthesis: Identifying Performance Measures, Indicators and Targets to Monitor and Evaluate Dementia Strategies External link, opens in new window. 2018.
- Back to reference 6 in text
- Yaffe MJ, Orzeck P, Barylak L. Family physicians’ perspectives on care of dementia patients and family caregivers External link, opens in new window. Canadian Family Physician. 2008.
- Back to reference 7 in text
- Pimlott NJG, et al. Family physicians and dementia in Canada External link, opens in new window. Canadian Family Physician. 2009.
- Back to reference 8 in text
- Canadian Home Care Association. Informing the National Strategy for Alzheimer’s Disease and Other Dementias External link, opens in new window. 2018.