MINT Memory Clinics provide compassionate, collaborative care
Dr. Linda Lee has been a committed family physician in Kitchener-Waterloo for more than 30 years. Throughout her career, she began to recognize gaps in how people living with dementia and other memory disorders were cared for. After becoming aware of her patients’ memory concerns, both Lee and her patients experienced challenges in accessing counselling supports, education, in-home care and specialists like geriatric psychiatrists or cognitive neurologists. Waitlists and barriers to access — like patients having to drive long distances to multiple agencies — made the system far from user-friendly.
“I recognized how people living with dementia were being cared for,” says Lee, who is also a researcher and associate clinical professor in the department of family medicine at McMaster University and a Schlegel Research Chair in Primary Care for Elders. “I decided what was needed was a model to address these issues through the primary care system.”
In 2006, she opened the first of what are now called the MINT Memory Clinics in her hometown. MINT is an acronym for multispecialty interprofessional team, and that sums up its unique approach to partnership. One referral to a MINT clinic (there are now 115 of these no-cost sites operating in Ontario) will give the client and family access to a full assessment with a comprehensively-trained team of professionals such as family doctors, nurses, social workers and staff from local Alzheimer societies when available — at one time in one location. Unnecessary medicines may be described, and more appropriate ones may be prescribed, information is shared, strategies are organized, and follow-up plans are scheduled on the spot.
This progressive model is reaping personal and system benefits — 96 per cent of patients and caregivers surveyed said they would recommend it. An independent provincial evaluation showed clients using MINT clinics had fewer trips to the emergency department, fewer hospitalizations and stayed at home longer. Only 10 per cent needed referral to a specialist, instead of 100 per cent of people with dementia who were not associated with a MINT clinic. Now, wait lists for accessing dementia care are 50 per cent shorter with MINT clinics in place and wait times for accessing specialist care are shorter as these are reserved for only the most complex cases, says Lee. It is estimated that MINT clinics have provided service to over 50,000 individuals (patients and caregivers) to date.
And the MINT model is reaching diverse groups — clinics are located in Korean, Cantonese, Francophone and Indigenous communities (many staff are fluent in respective languages). The clinic has also served people who are homeless and those who live in rural environments.
Lee has developed a nationally accredited training program for MINT clinic team members. The five-day curriculum (three days of workshops; two days of on-site training), covers topics such as delirium, depression, dementia and other memory disorders, medication optimization, driving safety, lifestyle interventions and addressing caregiver needs. And, during the first two days of a new clinic’s opening, Lee and her team provide one-on-one mentoring to help members work together as a highly functioning team.
This proactive care model provides ethical and compassionate help across the trajectory of the dementia experience, she explains. “It is about adapting the model — according to best practises and guidelines — to serve the client. There is a lot to consider for an accurate diagnosis, assessment and a comprehensive plan of management.”
To Lee’s knowledge, it is the first primary care initiative of its kind with published outcomes that demonstrate impact in improving health system capacity for dementia care.
Currently, Lee is expanding MINT clinics outside of Ontario. “We are excited to share this model of true collaboration,” she says. Calgary is expected to open four test sites in the spring of 2021.
Lee is honoured to spearhead this drive moving forward. “Dementia affects people in such a life-changing way,” she says. “If we can deliver the kind of care that older adults deserve, we will have done our job.” [ ]