Physicians' perceptions of capacity building for managing chronic disease in seniors using integrated interprofessional care models.
OBJECTIVE
To explore the barriers to and facilitators of adapting and expanding a primary care memory clinic model to integrate care of additional complex chronic geriatric conditions (heart failure, falls, chronic obstructive pulmonary disease, and frailty) into care processes with the goal of improving outcomes for seniors.


METHODS
Mixed-methods study using quantitative (questionnaires) and qualitative (interviews) methods.


METHODS
Ontario.


METHODS
Family physicians currently working in primary care memory clinic teams and supporting geriatric specialists.


METHODS
Family physicians currently working in memory clinic teams (n = 29) and supporting geriatric specialists(n = 9) were recruited as survey participants. Interviews were conducted with memory clinic lead physicians (n = 16).Statistical analysis was done to assess differences between family physician ratings and geriatric specialist ratings related to the capacity for managing complex chronic geriatric conditions, the role of interprofessional collaboration within primary care, and funding and staffing to support geriatric care. Results from both study methods were compared to identify common findings.


RESULTS
Results indicate overall support for expanding the memory clinic model to integrate care for other complex conditions. However, the current primary care structure is challenged to support optimal management of patients with multiple comorbidities, particularly as related to limited funding and staffing resources. Structured training, interprofessional teams, and an active role of geriatric specialists within primary care were identified as important facilitators.


CONCLUSIONS
The memory clinic model, as applied to other complex chronic geriatric conditions, has the potential to build capacity for high-quality primary care, improve health outcomes,promote efficient use of health care resources, and reduce healthcare costs.
Linda
L
Lee
George
G
Heckman
Robert
R
McKelvie
Philip
P
Jong
Teresa
T
D'Elia
Loretta M
LM
Hillier
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000458:organization & administration; D001291:Attitude of Health Personnel; D057191:Capacity Building / Q000379:methods*; D002908:Chronic Disease / Q000628:therapy; D003299:Cooperative Behavior; D019468:Disease Management; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D006299:Health Services for the Aged / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010348:Patient Care Team / Q000458:organization & administration*; D010821:Physicians, Family / Q000523:psychology*; D011320:Primary Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires