Envisioning Better Approaches for Dementia Care

The vast majority of patients with dementia receive their care in primary care settings. Clinicians find it challenging to provide optimal care for these patients and their often-stressed and over burdened caregivers because current reimbursement mechanisms do not support the kinds of practical, time-intensive, team-based processes of care that have been associated with improved outcomes in these settings (1, 2). In this issue, 2 care interventions are described demonstrating that the well-being of patients with dementia and their caregivers can be improved substantially (3, 4). However, clinicians may feel frustrated reading about these interventions because few will be able to implement them for their patients.

Vickrey and colleagues (3) present the results of a novel disease management program for the primary care of dementia. Patients with dementia and their caregivers who were seen in randomly selected primary care clinics were assigned a case manager who worked with and trained the caregiver, assessed and prioritized patient and caregiver needs, and recommended interventions to health care and community service providers. The role of the case manager in integrating care needs within primary care practices and across community service agencies was a novel feature of the program. Quality of care, as measured by adherence to guidelines, was dramatically higher in patients who received the intervention (64% vs. 33%). Patient quality of life improved, and caregivers reported improved social support, mastery of caregiving, and confidence. This intervention bears many similarities to an approach described by Callahan and colleagues (2) that also dramatically improved the processes and outcomes of dementia care.

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