Utilization of Health Services Before and After Diagnosis in a Specialist Rural and Remote Memory Clinic

• Published in: Canadian geriatrics journal CGJ Vol. 26; no. 3; pp. 350 - 363
• Main Authors: Kosteniuk, Julie, Morgan, Debra G., Acan Osman, Beliz, Islam, Naorin, O'Connell, Megan E., Kirk, Andrew, Quail, Jacqueline M., Osman, Meric
• Format: Journal Article
• Language: English
• Published: Vancouver Canadian Geriatrics Society 01-09-2023
• Subjects: Alzheimer's disease; Caregivers; Cohort analysis; Dementia; Health services; Hospitalization; Hospitals; Interdisciplinary aspects; Long term health care; Medical diagnosis; Medical personnel; Medical referrals; Memory; Older people; Original Research; Palliative care; Patients; Personal health; Polypharmacy; Prescription drugs; Rural areas; Sociodemographics; Canada; Saskatchewan Canada
• ISSN: 1925-8348; 1925-8348
• DOI: 10.5770/cgj.26.653

Background
Limited research exists on the use of specific health services over an extended time among rural persons with dementia. The study objective was to examine health service use over a 10-year period, five years before until five years after diagnosis in the specialist Rural and Remote Memory Clinic (RRMC).
Methods
Clinical and administrative health data of RRMC patients were linked. Annual health service utilization of the cohort (N = 436) was analyzed for 416 patients pre-index (57.5% female, mean age 71.2 years) and 419 post-index (56.3% female, mean age 70.8 years). Approximately 40% of memory clinic diagnoses were Alzheimer’s disease (AD), 20% non-AD dementia, and 40% mild or subjective cognitive impairment or other condition. Post-index, 188 patients (44.9%) moved to permanent long-term care and were retained in the sample; 121 patients died (28.9%) and were removed yearly.
Results
Over the ten-year study period, a significant increase occurred in the average number of FP visits, all-type drug prescriptions, and dementia-specific drug prescriptions (all p <.001). The highest proportion of patients hospitalized was observed one year pre-index, the highest average number of specialist visits was observed one year post-index, and both demonstrated a significant decreasing trend in the five-year post-index period (p = .037).
Conclusions
A pattern of increasing FP visits and drug prescriptions over an extended period before and after diagnosis in a specialist rural and remote memory clinic highlights a need to support FPs in post-diagnostic management. Further research of longitudinal patterns in health service utilization is merited.