Patients with dementia dwelling in the community and their caregivers express different unmet needs in social, psychological, and physical aspects of life. Primary health care is not yet prepared to address the needs of these populations. Case management has been proposed as one of the best solutions to face these challenges. It represents a collaborative work of family doctors and nurses in primary care. It was widely implemented in different countries and also in Quebec. It represents a key innovation of the Alzheimer Plan of Quebec initiated in 2009.
Different models of case management exist and have been implemented in the family medicine practices of Quebec: all family physicians diagnose, treat and support the patients with dementia and their caregivers (classic model, in majority of practices) or the patients and caregivers are evaluated and treated by a family physician with an additional expertise in dementia (expert model, minority of practices).
The objective of the research program is to compare the impact if the two case management models on the needs of the vulnerable populations and on the acute service use such as emergency department visits and hospital admissions for the conditions that could be managed in the community. We will conduct three studies in six family medicine practices across Quebec: 1) assessment of the needs, 2) evaluation of acute services use, and 3) opinion of patients, their caregivers and health care providers on the factors that need to be improved to better manage dementia in the community.