Results and lessons learned from the proactive memory care study

Background: Primary care physicians (PCPs) face numerous constraints to providing optimal dementia care. Recent randomized controlled trials using advanced practice nurses (APNs) to enhance PCP care for patients and family caregivers (CGs) yielded favorable results; however, none has been successfully implemented and sustained in community-based PCP settings. We report pilot results from Proactive Memory Care (PMC), a public health-oriented, APN-led intervention in partnership with three community-based PCP group practices. Methods: We targeted community-dwelling patients age >50 with recent PCP-diagnosed irreversible dementia, and their CGs. The 12-month in-home intervention included comprehensive clinical assessments and non-pharmacologic dementia care-related protocols. Controls received in-home visits to learn about available dementia-related educational and community resources. Patient outcomes were 12-month changes in neuropsychiatric symptoms and quality of life; CG outcomes were changes in depressive symptoms, burden, and dementia management self-efficacy. Patients, CGs, and PCPs independently rated satisfaction with the intervention. Results: Twenty-one intervention group and 10 control group dyads participated. Patient and CG outcomes did not differ by treatment group, but neither patient group experienced measurable cognitive decline over the 12-month observation period. Patients, CGs, and PCPs reported overwhelming satisfaction with the intervention. Conclusions: While detection of intervention effects was hampered by unchanged patient cognition and small samples, the PMC intervention showed promise as an acceptable dementia care model from multiple stakeholder perspectives. Recruitment challenges will help inform future efforts to partner APNs with community-based PCP networks to provide coordinated dementia care consistent with Patient-Centered Medical Homes and Medicare Accountable Care Organizations.