Family physician and specialist care for persons with dementia living in the community: through thick and thin

Background — Persons with dementia living in the community are vulnerable to service disruptions as they rely on a mix of outpatient care from different types of physicians. To demonstrate how outpatient physician visits evolved among persons with dementia during a health crisis compared to the prior year.

Methods — Using administrative databases, two retrospective cohorts (2019/pre-COVID-19 pandemic; 2020/pandemic) of community-dwelling persons with dementia aged 65+ were identified within three Canadian provinces (Alberta, Ontario, and Quebec). We measured the rates of visits (total/virtual/in-person) to family physicians, cognitive specialists (neurologists, geriatricians, and psychiatrists), and other specialists. Provincial incident rate ratios (IRR) and 95% confidence intervals (CIs) were calculated by comparing three pandemic periods (first wave; interim period; second wave) to the corresponding pre-pandemic periods (reference) and subsequently pooled using a meta-analysis to obtain overall estimates.

Results — Pre-pandemic (n = 160 288) and pandemic (n = 166 392) cohorts had similar characteristics. Although significant increases in family physician visits within provinces were observed during certain periods, there was no significant change in overall estimates compared to pre-pandemic levels. Overall cognitive (IRR 0.85, CI 0.80–0.90) and other specialist (IRR 0.71, 0.56–0.90) visits were significantly lower in the first wave compared to pre-pandemic period. There was a significant increase in virtual visits and a significant decline in in-person visits across all physician types throughout the pandemic periods.

Conclusion — Family physicians are the cornerstone of sustaining dementia care during health crises such as the COVID-19 pandemic, in part due to virtual care. Future research may investigate long-term outcomes of abrupt disruption in specialist and other community care.