Table 4 Rural memory clinic team members' perspectives of factors influencing sustainability and spread and associated RaDAR activities
Factors influencing sustaining and spreading memory clinics | How it helps | RaDAR Strategies supporting sustainability and spread of rural PHC memory clinics |
|---|---|---|
BOTH SUSTAIN AND SPREAD | ||
Positive outcomes for patients & families | -rural communities aging but have limited services -knowing that the clinic is addressing gaps and meeting needs in the community makes teams want to start a clinic and to continue - community awareness that help is available leads to continued referrals -patient and family more comfortable with familiar health care team members -clinics avoid travel/wait times for urban specialists -clinics provide “one-stop shop” with access to all services and provide “wrap-around” support -families feel relief at getting help and less alone and isolated; they know where to go for help -clinics are resulting in earlier diagnosis and management, provision of supports, less stigma | -collecting research data on clinic outcomes that are shared with teams in reports and presentations; reinforces positive impact of the clinics -teams have presented on their clinics and the benefits at the annual RaDAR Rural Dementia Summits and national conferences |
Well-developed clinic processes and tools | -clinic has core components but is adaptable depending on available health care professionals -everything needed is ready to use -less daunting to start a clinic -less time investment required by teams than trying to start a memory clinic on their own -standardized process provides structure to follow -reduces uncertainty about what is expected -education sessions build capacity and confidence -clinics are more efficient for some team members | -collaborated with teams to adapt PC-DATAa [39] flow sheets for team-based care in rural context and embed in EMR -created clinic Handbook compiling all clinic resources; provided copy to each team member; updated annually -supported team members to visit specialist memory clinic at university, attend annual RaDAR Summit, and travel with RaDAR to national conferences -researchers shared innovations developed by teams with other teams |
Clinic champion and engaged confident leader | -confident, enthusiastic leader acts as a champion for new teams, creating interest and excitement -clinics need a consistent leader who knows the clinic processes and provides direction -clinic leads need skills in both dementia care and leadership in order to lead the implementation | -support clinic leads to develop capacity, e.g., attend dementia conferences, attend RaDAR training sessions |
Facilitation and problem-solving | -local PHC facilitator (health region position) helps with communication, scheduling clinics and meetings, developing clinic resources/processes -local facilitators have coordination and quality improvement role, so it is good fit with the clinics -Facilitators and researchers help trouble-shoot and problem-solve to resolve problems early -RaDAR team facilitation keeps teams accountable | -hired Team 1 nurse practitioner part-time to provide leadership and clinical support to teams -hired former Team 1 facilitator living near the teams to attend all clinics, provide operational guidance and collect research data -hold regular workgroup meetings with teams following each clinic to debrief, and problem-solve -hold monthly “check-in” meetings with PHC facilitators and managers to identify/address sustainability issues |
Organizational and leadership support | -manager support gives team members permission to engage in developing and practicing in the clinics -access to resources is driven by health system strategic priorities and direction of leadership -health region reorganization underway aligns with the clinic goals of team-based care | -RaDAR research guided by a Steering Committee of all regional Directors and Alzheimer Society leadership -Primary healthcare directors and managers invited to regular team workgroup meetings -connected with provincial health authority leadership to consult about spread strategies |
SUSTAIN | ||
Team passionate and engaged | -commitment and belief in the program help teams collaborate to refine and adapt clinic processes -engagement creates motivation to make the clinic a priority as other demands on teams increase -maintaining a cohesive team requires shared decision-making so all members feel involved -determination to continue during the Covid-19 pandemic shown by adapting to new restrictions | -hold regular workgroup meetings with memory clinic teams and RaDAR researchers to facilitate team communication and decision-making, and keep clinic front of mind |
Continuity of team members | -recruitment of healthcare professionals in rural areas can be challenging thus consistency of members helps clinic run smoothly -experienced team members are able to support a new clinic lead while they gain experience | - the clinic handbook is a resource for new members -the EMR manager orients new team members to PC-DATA [36] in the EMR -researchers help orient new facilitators to the clinic -researchers provide 1–1 and group orientations -clinic leads are essential in orientation |
Positive outcomes for team members | -team members are more comfortable with each other and working together -collaborations have spread to work outside clinic -team members are more aware of each other’s practice and contributions to dementia care -team members have more information to work with, improving individual/joint recommendations -Alzheimer Society can establish relationship with patient and family to discuss needs and supports -clinics are efficient for some team members because assessments and planning are coordinated in one visit -team approach is gold standard; takes pressure off individual members for issues such as driving | -regular workgroup meetings helps teams to continually improve care coordination -researchers provide regular reports on clinics to the Steering Committee and health authority leadership, underscoring the valuable service teams are providing |
SPREAD | ||
Sustained, successful pilot clinic | -demonstrates that clinic is possible in small rural community and is effective -pilot clinic’s success motivates new teams to start, appeals to team competitiveness -pilot clinic members can engage colleagues in other communities to stimulate interest | -supported development, printing, and distribution of a brochure describing rural PHC memory clinic goals, referral process, assessment process, and benefits. -funded a professional video of a clinic day to raise awareness in community and health care https://www.youtube.com/watch?v=Tzr1MVu7Mpc -memory clinic teams present at annual RaDAR Rural Dementia Summit to share clinic processes, successes |
Identify teams with interest, capacity and resources | -focus on teams with interest and resources because both are needed to thrive and survive -let new teams know team composition is flexible -ensure potential new teams are aware of benefits for patients, families, and their own practice -spread is facilitated when there is overlap of team members between new and existing teams | -meet with regional Directors and Managers to identify potential new teams with interest/capacity to start clinic -provide resources to teams where needed to address gaps, such as conference phones, laptops -identifying and engaging teams with interest is part of role of the Team 1 nurse practitioner (hired part-time by RaDAR). |
Shadowing and mentoring opportunities | -the most effective strategy for inspiring new team members is to observe a clinic in action to see the value for patients, families, and team members -connecting new members with their counterpart on an existing team helps orient and educate about their role, and provides reassurance | -shadowing and mentoring is built into planned spread strategy: Team 1 nurse practitioner and former team facilitator hired by RaDAR to support teams in starting up and sustaining clinics; new members will be matched with experienced counterpart mentor; opportunity for new members to shadow existing clinics. -delivered initial and ongoing education sessions |