Integrating AAA Care Coordinators in Primary Care for Dementia Support: Implementation Challenges and Lessons Learned

Area of Science:

• Gerontology
• Primary Care Medicine
• Public Health

Background:

• Barriers in patient, provider, and community factors impede dementia diagnosis and management in primary care.
• Current EHR-based interventions with minimal training are inadequate for addressing these multifaceted challenges.
• A comprehensive approach is needed to enhance early detection, improve dementia care, and support the well-being of patients and caregivers.

Purpose of the Study:

• To evaluate the effectiveness of an intervention integrating Area Agency on Aging (AAA) care coordinators into primary care for dementia care.
• To assess the impact of enhanced provider training and community support awareness on dementia diagnosis and management.

Main Methods:

• Retrospective evaluation of secondary data from a dementia care intervention.
• Intervention included a clinical workflow, semiannual dementia training, and AAA care coordinator integration.
• Data analyzed from three primary care clinics during 2023.

Main Results:

• Seventeen caregivers received education and support referrals over the intervention period.
• This support reached 5.3% of the 322 dementia patients seen at the clinics.
• While provider referrals increased, dementia care referrals decreased proportionally.

Conclusions:

• Area Agency on Aging care coordinators represent a viable model for addressing health-related social needs in primary care.
• Significant complexities and challenges remain in optimizing dementia care within primary care settings.