Abstract
Background: Primary health care has a central role in dementia detection, diagnosis, and management, especially in low-resource rural areas. Care navigation is a strategy to improve integration and access to care, but little is known about how navigators can collaborate with rural primary care teams to support dementia care. In Saskatchewan, Canada, the RaDAR (Rural Dementia Action Research) team partnered with rural primary health care teams to implement interprofessional memory clinics that included an Alzheimer Society First Link Coordinator (FLC) in a navigator role. Study objectives were to examine FLC and clinic team member perspectives of the impact of FLC involvement, and analysis of Alzheimer Society data comparing outcomes associated with three types of navigator-client contacts.
Methods: This study used a mixed-method design. Individual semi-structured interviews were conducted with FLC (n = 3) and clinic team members (n = 6) involved in five clinics. Data were analyzed using thematic inductive analysis. A longitudinal retrospective analysis was conducted with previously collected Alzheimer Society First Link database records. Memory clinic clients were compared to self- and direct-referred clients in the geographic area of the clinics on time to first contact, duration, and number of contacts.
Results: Three key themes were identified in both FLC and team interviews: perceived benefits to patients and families of FLC involvement, benefits to memory clinic team members, and impact of rural location. Whereas other team members assessed the patient, only FLC focused on caregivers, providing emotional and psychological support, connection to services, and symptom management. Face-to-face contact helped FLC establish a relationship with caregivers that facilitated future contacts. Team members were relieved knowing caregiver needs were addressed and learned about dementia subtypes and available services they could recommend to non-clinic clients with dementia. Although challenges of rural location included fewer available services and travel challenges in winter, the FLC role was even more important because it may be the only support available.
Conclusions: FLC and team members identified perceived benefits of an embedded FLC for patients, caregivers, and themselves, many of which were linked to the FLC being in person.
Plain Language Summary
Care models for dementia that include a care navigator (someone who helps the caregiver) usually have better outcomes. This study was conducted in Saskatchewan, Canada. The Rural Dementia Action Research team partnered with rural primary health care teams to offer memory clinics that included an Alzheimer Society First Link Coordinator, a role that includes care navigation. We were interested in the perspectives of the Coordinators and clinic team members on the impact of First Link Coordinator involvement on caregivers and team members. We also compared outcomes for three types of Coordinator-client contacts using data from the Alzheimer Society. Individual interviews were conducted with First Link Coordinators and clinic team members involved in five memory clinics. Three key themes were identified: benefits to patients and families who had contact with a First Link Coordinator, benefits to memory clinic team members, and how rural location affected the Coordinator role. Whereas other team members were involved in assessing the patient, First Link Coordinators were the only members focused on caregivers, providing emotional support, connection to services, and symptom management. Face-to-face contact helped First Link Coordinators establish a relationship with caregivers that facilitated future contacts. Team members were relieved knowing caregiver needs were addressed and learned about dementia subtypes and available services they could recommend to non-clinic clients. Although rural locations had fewer services and travel was challenging for First Link Coordinator in winter, the First Link Coordinator role was even more important in rural communities as it could be the only available support.