Dementia care in the context of primary care reform: an integrative review

Abstract

Objectives: The purpose of this review was to determine the influence of the growing body of evidence about the attributes of high-performing primary care systems on the literature related to the primary care of people living with dementia.

Methods: In this integrative review, we examined a broad range of published and grey literature (2000–2013) about the primary care of dementia, using a systematic approach set up in advance of the literature search. The review was guided by two questions: What are the evident models of primary care for dementia? How do the models line up with the other attributes of high-performing primary care?

Results: Three models were noted: carved-out, co-managed, and integrative-hub, all informed by different assumptions about the role of primary care in dementia. The models varied in alignment with the attributes of high-performing primary care, although we found very little attention to accessibility, relational continuity or comprehensiveness of care.

Conclusions: We know what we need to pay attention to in building our primary care system – and no population will put the performance of primary care more to the test over the next two decades than the rapidly growing number of people who will be living with complex chronic conditions like dementia. Recent literature around primary care and dementia shows promise in attending to some of the attributes of high-performing primary care, yet much more work is needed if we are to truly leverage the potential value of primary care in addressing the needs of these complex and numerous future patients.

Keywords:

• Alzheimer disease
• other dementias
• cognitive functioning
• service provision
• primary care

Acknowledgements

The authors wish to express their gratitude to Marion Allen (RN, PhD – Professor Emerita), University of Alberta, for her contributions in constructing the quality assessment framework for theoretical papers included in the review.