title: Provision of dementia-related services in Canada: a comparative study.
abstract: Dementia is common, particularly among older adults, and is one of the major causes of dependency later in life. We sought to provide an overview and comparison of key services related to dementia care as the disease progresses in three large Canadian healthcare centres.
  
  
  
  We identified family physicians, geriatric specialists, and dementia case managers from three major population centres in Canada with universal healthcare coverage. Using a standardized longitudinal dementia case vignette, participants were interviewed on services they would provide at each stage of the disease. We used principles of content analysis to generate codes and identify themes; appropriate time frames from the vignette fitting the necessary provision of services were derived from the Canadian consensus statement and determined in consultation with clinical experts. Proportions of participants that identified dementia-related care services were analyzed at each time point of the vignette using chi-square tests.
  
  
  
  Thirty-four healthcare providers from Calgary (Alberta), Edmonton (Alberta), and Ottawa (Ontario) participated. Review of our data identified seven overarching themes of dementia-related care services. Services provided in the community setting include future planning and related services, educational and social support services, and home care and respite services. Although all providers consistently identified educational and social support services (e.g. the Alzheimer Society) within the appropriate time frame, the provision of other services was variable. The proportion of providers reporting potential access of future planning services was significantly different across the three sites (Calgary, 91.7 %; Edmonton; 58.3 %; and Ottawa, 30.0 %), p = 0.012. Also, the proportion of providers that identified day program services were significantly different across the three sites (Calgary, 100.0 %; Edmonton, 91.7 %; and Ottawa, 60.0 %), p = 0.023 according to a chi-square test.
  
  
  
  We found important types of variability in service delivery among different regions in Canada for a typical patient with dementia and their family caregiver. Health systems can be calibrated by aligning services from different settings to appropriate time points in the vignette, which illustrates the dynamic course of service delivery and opportunities for improvement throughout the disease trajectory.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. tamh@ucalgary.ca.
authors.forename: Helen
authors.initials: H
authors.lastname: Tam-Tham
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.|Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Alberto
authors.initials: A
authors.lastname: Nettel-Aguirre
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Silvius
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Dalziel
authors.affiliation: Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.|Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Garcia
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Frank
authors.initials: F
authors.lastname: Molnar
authors.affiliation: Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Drummond
mesh_terms: D000328:Adult; D000416:Alberta; D017028:Caregivers; D003631:Day Care, Medical / Q000592:standards; D003695:Delivery of Health Care / Q000592:standards*; D003704:Dementia / Q000628:therapy*; D005260:Female; D006266:Health Education / Q000592:standards; D006282:Health Personnel; D006699:Home Care Services / Q000592:standards; D006801:Humans; D008297:Male; D009864:Ontario; D010821:Physicians, Family; D012017:Referral and Consultation; D012144:Respite Care / Q000592:standards; D012944:Social Support; D012947:Social Work
keywords: Canada; Dementia; Health services delivery; Vignette