A Stakeholder-Engaged Process to Design and Implement the Assessment of Cognitive Complaints Toolkit for Alzheimer's Disease (ACCT-AD) in Primary Care

Abstract

Background: Dementia is underdiagnosed, particularly in primary care settings where most people receive their healthcare. These is a need for tools to assist with the diagnosis of dementia by primary care clinicians, who greatly outnumber specialists.

Objective: To describe the collaborative design process, implementation, and lessons learned when developing a new cognitive assessment tool for primary care settings.

Design and participants: We used an iterative approach to develop, test, and revise the Assessment of Cognitive Complaints Toolkit for Alzheimer's Disease (ACCT-AD), and used qualitative and survey-based methods to identify lessons learned from its use in four community primary care practices in California.

Key results: Lessons learned from implementing the ACCT-AD toolkit in community primary care practices include the importance of stakeholder engagement in the process, assessing and adapting workflow, staffing, and approach; the educational value of the toolkit as a systematic tool, user response to the toolkit, and challenges around workflow, integration, and sustainability.

Conclusions: The design and implementation of the ACCT-AD toolkit explicitly target workforce constraints that will continue to emerge as demand for cognitive assessment increases. Our approach, which enables primary care clinicians to complete a thorough assessment within their practice, supports building on the strong foundation of the doctor-patient relationship in primary care, and can lead to earlier diagnosis and more efficient referrals.

Keywords: cognitive assessment; dementia; diagnosis; primary care.

Figure 1

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Figure 2

How useful was the ACCT-AD Toolkit for identifying a probable diagnosis?