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

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.

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.

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.

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.