Quality Statement 10: Access to Primary Care - Health Quality Ontario (HQO)

Resources Quality Statements Advisory Committee About

Access to Primary Care

People living with mild cognitive impairment or dementia have regular visits with a primary care physician or nurse practitioner who provides effective primary care that meets both their general health care needs and their specific needs related to cognitive impairment or dementia.

Background

Primary care plays a critical role in managing the complex health needs of people living with mild cognitive impairment or dementia. This care involves both their general health care needs and their needs related to cognitive impairment or dementia, as well as their caregivers’ health care needs.

More than 90% of community-dwelling seniors with dementia in Ontario have two or more coexisting chronic medical conditions, whose courses are often complicated by dementia. As dementia progresses, people experience challenges with memory, symptom awareness, decision-making, and expressive language, which can make it difficult for them to manage their general health and coexisting chronic conditions. It can be hard to adhere to medication regimens and to monitor themselves and perform the self-care required to effectively manage conditions such as diabetes, heart failure, and chronic obstructive pulmonary disease. Chronic conditions can become de-stabilized and exacerbated when a person has dementia, potentially resulting in visits to the emergency department, hospitalizations, deconditioning (muscle loss owing to inactivity) and earlier institutionalization.

To address these challenges, people living with dementia or mild cognitive impairment and their caregivers need timely access to primary care that:

Is person-centred (rather than disease-focused)
Is continuous and comprehensive for most health needs
Is coordinated and links to other health care professionals and resources across the health care system, as needed
Addresses individual needs and aligns with the person’s goals of care

Primary care also provides a critical link to specialist care and specialty programs, such as specialty dementia care and specialized geriatric services. To address complex medical and behavioural issues, functional complexity, and certain stages of illness, it is important for primary care clinicians to collaborate with, and get support from, specialists in dementia care, such as geriatricians, geriatric psychiatrists, and cognitive neurologists, as well with community support agencies.

What This Quality Statement Means

For People Living With Mild Cognitive Impairment or Dementia

You should have a family physician or nurse practitioner who sees you regularly and knows your needs. This health care professional should monitor your health, provide care, and link you and your caregivers to other health care providers and support services that meet your changing needs and goals.

For Clinicians

Ensure that people living with dementia or mild cognitive impairment have access to a primary care provider to visit regularly. This individual provides person-centred, comprehensive, and coordinated care to meet their needs.

For Health Services

Ensure that people living with dementia have access to a primary care provider. Ensure the system can accommodate the provision of effective primary care to support the dynamic needs of those living with dementia.

Quality Indicators

Process Indicators

Percentage of people with mild cognitive impairment who have visited their primary care provider in the past 12 months

Denominator: number of people living with mild cognitive impairment
Numerator: number of people in the denominator who have visited their primary care provider in the past 12 months
Data sources: Ontario Health Insurance Plan (OHIP) Claims Database or local data collection

Percentage of people with dementia who have visited their primary care provider in the past 6 months

Denominator: number of people living with dementia
Numerator: number of people in the denominator who have visited their primary care provider in the past 6 months
Data sources: Ontario Health Insurance Plan (OHIP) claims database or local data collection

Definitions Used Within This Quality Statement

Regular visits

A person living with mild cognitive impairment should visit their primary care provider every 6 to 12 months, or sooner according to clinical need.

A person living with dementia should visit their primary care provider every 3 to 6 months, or sooner according to clinical need.

Effective primary care

Primary care is the person’s first contact with the health system. It is effective when it:

Is person-focused; rather than focusing on the disease or a single condition, it focuses on the whole person
Is accessible
Provides comprehensive care for most health needs (in collaboration with specialists, as needed)
Coordinates and integrates care and services when a referral to other health care professionals or home and community support services is required
Continues over time
Links to and gets support from specialists, as needed

Evidence to Improve Care