Family physicians' perspectives on outcomes, processes, and policies in dementia care

The rapid rise in numbers of people living with Alzheimer's disease and related disorders (ADRD) poses major challenges to health systems and policy. Although primary care clinicians provide ongoing medical care for 80% of affected individuals, they face persistent barriers to providing high-quality dementia care. We conducted qualitative interviews with family physicians (n = 20) to understand what core outcomes they consider most important and what care processes and systems and policy strategies they propose to achieve them. Participants identified processes and outcomes pertaining to their relationships with patients and families, involvement in overall medical care, and efforts to mitigate harm as key components of dementia care. Participants also identified overarching patient care values: making active efforts to maintain continuity in the doctor-patient-family relationship, communicating clearly, building and sustaining trust, and responding to health-related social needs. Policy recommendations included work to create health care systems capable of providing comprehensive dementia care, full integration of caregivers into psychosocial care and medical management, adjustments to care cadence, and payment models that support team-based primary care. Findings could help refocus care improvement efforts on implementing the vital conditions for optimal health that can be achieved in primary care and sustained through the course of dementia.