The role of a specialized memory clinic supporting primary care providers in a safety net health system - PubMed (original) (raw)

The role of a specialized memory clinic supporting primary care providers in a safety net health system

Elizabeth Bartelt Joe et al. BMC Prim Care. 2025.

Abstract

Background: Although most dementia care occurs in primary care, consultation with dementia specialty care is sometimes indicated. Access to dementia specialists is limited, particularly in resource-limited environments such as the public health safety net, which may require triaging referrals to preserve access for patients with needs that can not be met in a primary care setting.

Methods: The eConsult system for primary care providers to refer patients to a subspecialty memory clinic is described for a large safety net health system. Demographic and clinical characteristics are presented for patients evaluated within the memory clinic setting compared to the health system overall. ICD-10-CM codes were used to identify cognitive diagnoses and medical comorbidities. Chi-squared tests were used to compare categorical variables and t-tests for continuous variables.

Results: 94 individuals age 50 or older were seen in the memory clinic in 2019, of whom 43 were new evaluations. The most common visit diagnoses for new memory clinic patients were Alzheimer's disease (33%), no cognitive diagnosis (28%), unspecified dementia (19%), and mild cognitive impairment (12%); for follow up patients, the most common diagnoses were Alzheimer's disease (49%), unspecified dementia (18%), no cognitive diagnosis (14%), and mild cognitive impairment (10%). For those without a cognitive diagnosis, common visit diagnoses included cognitive symptoms, mood or sleep disorders, and metabolic disturbances. Of the 11 new internal referrals with a prior coded diagnosis of dementia, median time from first diagnosis to their initial memory clinic visit was 224 days.

Conclusions: Despite clear systemwide parameters for referral and extensive pre-referral screening via an eConsult system, the most common diagnosis for memory clinic patients was Alzheimer's disease. Direct studies of eConsult are needed to determine primary care providers' needs when referring patients with dementia to a memory clinic setting.

Keywords: Dementia health services; Memory clinics; Public health safety net.

© 2025. The Author(s).

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was determined to be exempt from 45 CFR 46 according to § 46.104(d) as category 4 by USC’s Institutional Review Board (protocol HS-21-00814), and the requirement for informed consent was therefore waived. All research was conducted with ethical standards in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: FSG receives salary support from Los Angeles County Department of Health Services.

Figures

Fig. 1

Fig. 1

Memory clinic diagnoses at first 2019 encounter for new vs. follow up patients

Fig. 2

Fig. 2

Specified diagnoses at first 2019 memory clinic encounter

References

    1. Drabo EF, Barthold D, Joyce G, Ferido P, Chang Chui H, Zissimopoulos J. Longitudinal analysis of dementia diagnosis and specialty care among Racially diverse medicare beneficiaries. Alzheimers Dement. 2019;15(11):1402–11. -DOI -PMC -PubMed
    1. Thunell JA, Jacobson M, Joe EB, Zissimopoulos JM. Medicare’s annual wellness visit and diagnoses of dementias and cognitive impairment. Alzheimers Dement (Amst). 2022;14(1):e12357. -DOI -PMC -PubMed
    1. Liu JL, Hlávka JP, Hillestad R, Mattke S. Assessing the preparedness of the U.S. Health care system infrastructure for an Alzheimer’s treatment. RAND Corporation; 2017. -PMC -PubMed
    1. Amjad H, Roth DL, Sheehan OC, Lyketsos CG, Wolff JL, Samus QM. Underdiagnosis of dementia: an observational study of patterns in diagnosis and awareness in US older adults. J Gen Intern Med. 2018;33(7):1131–8. -DOI -PMC -PubMed
    1. Barnett ML, Yee HF, Mehrotra A, Giboney P. Los Angeles Safety-Net program eConsult system was rapidly adopted and decreased wait times to see specialists. Health Aff (Millwood). 2017;36(3):492–9. -DOI -PubMed

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