A pilot dementia shared care programme between geriatrician and primary care physician

Background: The prevalence of dementia is increasing in Hong Kong, as is the burden to the health and social care system. The Memory Clinic of Queen Mary Hospital has collaborated with the Elderly Health Centre (EHC) of Department of Health in the management of dementia since September 2018, with an attempt to develop a shared care model to enhance dementia care in EHC and to reduce the impact of dementia care on the tertiary care system. Objectives: To explore the feasibility of a shared care programme between primary care professionals of Department of Health and geriatrics specialists of Hospital Authority in the care of dementia patients. Methods: With consent, members of Sai Ying Pun EHC who attended the Memory Clinic were referred for shared care. Inclusion criteria were mild cognitive impairment or mild dementia (Clinical Dementia Rating of 0.5-1) with or without stable dose of cholinesterase inhibitor. Patients with behavioural and psychological symptoms of dementia (BPSD) were excluded. In the programme, an EHC multidisciplinary team (comprising doctor, nurses, clinical psychologist, occupational therapist, and physiotherapist) provided pharmacological treatment, cognitive and functional assessment and training, mood monitoring, and carer skill training. Patients were followed up annually (instead of the twice-to-thrice yearly) at Queen Mary Hospital. Results: From 1 September 2018 to 28 February 2019, 51 EHC members attended the Memory Clinic and 25 of them fulfilled the referral criteria. Only 6 women and 5 men (mean age, 83.8 years) were successfully referred to EHC for shared care. The mean Abbreviated Mental Test score was 7.5. Six EHC members had mild cognitive impairment and five had Alzheimer's disease. The remaining 40 EHC members were excluded for referral because of dementia medications not enlisted in EHC (40%), conditions warranting specialist follow-up (27.5%), significant behavioural and psychological symptoms of dementia (10%), without consent (10%), infrequent follow-up (annually) at Queen Mary Hospital (7.5%), and advanced dementia (5%). During the programme, one patient was referred back to Queen Mary Hospital for management of behavioural and psychological symptoms of dementia. Conclusion: Collaboration between primary care team of Department of Health and Memory Clinic of a hospital is feasible in the care of dementia patients. With the programme, patients have more opportunities to receive cognitive rehabilitation and care fo