Cathryn France: Much of primary care is still organized around brief visits and single concerns. Dementia diagnosis and care don’t fit that model
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For most families, dementia care doesn’t begin with a specialist appointment.
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It begins with a spouse noticing that something is different. A son wondering whether his mother is safe to drive. A daughter sitting in a family doctor’s office trying to explain, in a 15-minute appointment, that her father is repeating questions, missing medications and becoming frightened.
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Family physicians are often the first to respond to family concerns and begin difficult conversations about memory loss, safety, medications and future planning. They become a steady point of contact for families navigating a progressive and life-altering disease. This is particularly the case in rural communities with limited specialist access.
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That role is only going to grow. More than 85,000 people in B.C. are living with dementia, and that number will rise as the population ages. Dementia is already one of the most complex and resource-intensive health conditions facing the province, yet much of the challenge falls on family physicians who are trying to provide care within systems that are still built around short, episodic appointments.
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B.C.’s renewed physician main agreement recognizes several important pressures in the health-care system, including rural practice, maternity care, psychiatry and after-hours services. Those priorities matter. But it doesn’t explicitly prioritize dementia and geriatric care, which is also critical, given B.C.’s rapidly aging population.
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As dementia progresses, the family doctor’s role becomes more complex. A single appointment may involve reviewing medications, assessing safety, responding to changes in behaviour, supporting an exhausted caregiver and helping families make difficult decisions about what comes next. These are not one-issue visits, but emotional, time-intensive conversations that often require follow-up.
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Yet much of primary care is still organized around brief visits and single concerns. Dementia diagnosis and care don’t fit that model.
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B.C. has established, and subsequently improved, the longitudinal family physician payment model to support complex, continuing needs. But dementia care still requires more time, co-ordination, caregiver support and connection to community services than the system fully recognizes.
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What would better support for people living with dementia look like?
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It might include longer appointments, caregiver consultations, home visits and stronger co-ordination with home and community care. It could also include enhanced funding models that support the primary care memory clinic model, where physicians work with other health professionals to assess, diagnose and support people living with dementia. Dementia-specific quality incentives, including advance care planning, medication reviews and reducing avoidable hospitalization, would help make time-intensive dementia care more sustainable while improving outcomes for patients, families and the health-care system.
