Provincial Approach

PHC IGSI

Priorities to Enhance Wellbeing

In addition to learning from primary care teams through a 2015 scan of geriatric services in Primary Care Networks (PCNs) in Alberta, care partners of people living with dementia were consulted to understand the priorities they envisioned to enhance quality of life in community. The Messages from Dementia Care Partners underpin the work both at a provincial level, and with the local community teams participating in PHC IGSI. (Source Advancing Dementia Diagnosis and Management in Alberta [ADDMA] Workshop, 2016).

Anticipating the Future Framework

The Anticipating the Future Framework is in alignment with the Alberta Dementia Strategy and Action Plan and serves as a guide for participating teams. Implementation of the framework relies on two key elements:

  • A Provincial team who mentors and supports the participating community teams
  • Community teams who work to develop relationships and work collaboratively with partners from local health, social and community groups to identify priority areas and develop a shared action plan to support achieving those priorities.

The approach each community takes is unique and based on the identified local need. The provision of effective support for people living in the community with dementia, frailty or other geriatric syndromes requires intentional efforts of multi-sector partners to collaborate to offer integrated, quality care and support.

Primary Health Care Integrated Geriatric Services Initiative

The PHC IGSI completed a pilot phase from January 2017 to June 2018.

Key partners in this phase were the Seniors Health Strategic Clinical Network, the Primary Health Care Integration Network, the Alzheimer’s Society of Alberta and the Northwest Territories, five Primary Care Networks (PCNs).

With the support of the provincial PHC IGSI team, the participating PCNs and their respective communities began work locally to:

  • improve clinic processes
  • build relationships with local health, social and community partners
  • host provincial learning workshops and local educational events
  • engage people living with dementia and carers in both provincial and local planning.

The learnings from the pilot phase indicated that bolstering multi-sector relationships at the community level increased the local capacity to meet the needs of the aging population through:

  • community coalition development; and
  • action planning across health, social, community, municipal and public sectors.

Notable health system successes within the participating communities showed a decrease in:

  • unplanned emergency department visits, and
  • length of stay in acute care for those with a diagnosis of dementia.