LETTERS TO THE EDITOR
EFFECT OF PRIMARY CARE-BASED MEMORY
CLINICS ON REFERRALS TO AND WAIT-TIME FOR
SPECIALIZED GERIATRIC SERVICES
To the Editor: Primary care collaborative memory clinics
(PCCMC), were developed in Ontario, Canada, starting in
2006 to address challenges and build capacity for demen-
tia care at a primary care level. These family physician–led
interprofessional clinics provide comprehensive assessment
and management within a shared care approach and with
support from local geriatrics specialists.
model features elements of person-centered care, consid-
ered the criterion standard for the care of older adults.
There are more than 100 PCCMCs across the province,
and this is expected to increase over time.
There is much anecdotal evidence from previous evalua-
tions of this care model that the early identification and
intervention that the PCCMCs offer contribute to more effi-
cient use of existing specialist resources.
consistently demonstrated referral rates to specialists of
compared with typical referral
rates of up to 82% from family physicians for persons with
shortage of geriatricians in Canada.
Nevertheless, there has
been limited empirical evidence demonstrating effect on sys-
tem efficiency in the use of specialists, primarily because of
difficulties accessing valid system-level data. The purpose of
this current study was to examine the effect of the PCCMCs
on referrals to and wait-time for specialist consultation.
In the Wellington-Dufferin-Guelph region of southern
Ontario (population base of 265,240),
established in 2 large, rural primary care settings, (Clinics A
and B, located in Family Health Teams), serving 41 medical
practices with a combined patient base of 65,000. In this
region, geriatrician consultation is accessed through the Cana-
dian Mental Health Association—Waterloo Wellington
(CMHA-WW) Specialized Geriatric Services (SGS). The
CMHA-WW generated data from their information system
on the number of referrals to SGS for memory concerns from
the practice settings of both these clinics in the years before
and after launch and median wait-time (days), defined as the
difference between the date of referral and date of first assess-
ment, for all referrals to SGS and from each clinic practice
setting, regardless of reason. These data were provided for
each year from 2008 to 2014; data were not provided
beyond these years because, in 2015, a number of new initia-
tives (e.g., nurse-led assessment programs) were implemented
that also affected referral rates for specialist consultation.
Referrals to SGS for memory concerns from Clinic A’s
practice setting were lower each year after the implemen-
tation of the PCCMC (2009, n 5 94; 2010, n 5 67;
2011, n 5 78; 2012, n 5 73; 2013, n 5 56; 2014,
n 5 33) than in the year prior (2008, n 5 100), represent-
ing a 67% reduction in referrals to SGS in 2014 from
2008. Referrals to SGS from Clinic B’s practice setting
were higher in the year of implementation of the PCCMC
(2013, n 5 189) but lower the year after (2014, n 5 145)
than in the year before launch (2012, n 5 183)—a 21%
reduction in referrals to SGS from 2012 to 2014.
After the launch of the clinics, median wait-time for
SGS consultation decreased for referrals from both clinics’
practice setting (32% reduction for Clinic A, 47% for
Clinic B in wait-times in the year after launch from the
2008 2009 2010 2011 2012 2013 2014
Median wait time (days)
All SGS referrals Clinic A Clinic B
Figure 1. Median wait-time (days) for all referrals to Specialized Geriatric Services (SGS) and referrals from each memory clinic’s
practice setting from 2008 to 2014.
JAGS 66:631–636, 2018
2017, Copyright the Authors
2017, The American Geriatrics Society 0002-8614/17/$15.00