Main Submission Volume 3/Issue 1/2012 HealtH S cience i nquiry Volume 5 / Issue 1 / 2014 74 Vladimir Khanassov, Pierre Pluye, and Isabelle Vedel McGill University Dementa is a chronic disease characterized by progressive memory loss and behavioural disturbance. It has become a major concern for healthcare professionals due to the increasing number of people afected, usually presentng with more than one chronic conditon. 1 According to the World Health Organizaton (WHO), up to eight million new cases of dementa are detected world-wide annually. 2 Today in Canada, half a million people are living with dementa and this number is expected to rise two and a half tmes over the next 40 years due to an aging populaton. 3 The WHO has declared dementa to be one of the most serious health challenges facing our society due to its pronounced consequences on patents, their families and society. 2 Various elements contribute to this quandary including patent-caregiver dyad factors (e.g., fear of stgmatzaton) and healthcare system issues (e.g., fragmentaton of healthcare services). In this artcle we discuss Case Management (CM) designed for patents with dementa, and types of CM pertnent to primary care. Dementa and primary care: The current situaton The frst contact people with dementa have in the healthcare system is with a Family Physician (FP). The FP is thus ideally positoned to address their needs. Despite the fact that four Canadian consensus conferences on dementa have recommended FPs to be in charge of the preventon, diagnosis, and care for persons with dementa, 4 FPs are reluctant to deal with these patents due to a lack of knowledge and confdence in using cognitve screening tests, and poorly coordinated primary and secondary care services. 5 Unlike most European countries, Canada does not have a natonal plan on dementa partly due to the fact that healthcare is a provincial responsibility. To address this challenge, the provinces of Quebec and Ontario have developed dementa collaboratve care models in the context of a major primary care reform that integrates personalized dementa service delivery within Family Medicine Groups (Quebec) and Family Health Teams (Ontario). 6,7 One of the key innovatve interventons of these models is CM. 6,7 CM is defned as a collaboratve process in which a case manager assesses an individual’s health, plans a care path, coordinates health services, and monitors health status. This interventon aims for the tmely delivery of patent-centered, comprehensive, and inter-professional care throughout the course of the disease in primary care. A case manager works closely with FPs and can facilitate their workloads, allowing FPs to more efectvely focus on care. Patents with complex issues are referred to specialists (e.g., memory clinics). Dementa case management: A potental soluton? The results of studies on the efectveness of dementa CM have shown that it has the potental to improve outcomes. 8 A few systematc reviews have demonstrated the positve efect on clinical outcomes, service use, cost-efectveness, and caregiver satsfacton. 9 Varietes of CM models are described in the literature on disease management, including hospital and service-based models. However, it is not clear what types of CM models are pertnent to primary care as systematc reviews conducted to date combine all types of CM. 9 For example, there are no studies comparing case managers working independently versus case managers working in collaboraton with other healthcare professionals (FPs and/or specialists). An ideal combinaton appears to be a case manager working in collaboraton with FPs: “an FP treats and a case manager organizes”. There is also no agreement about the best combinaton of healthcare professionals to address the needs of patents with dementa. Some researchers do not consider the direct involvement of a physician and a multdisciplinary team to be essental for CM efectveness. 10  Dementia in Canadian primary health care: The potential role of case management Primary Health Care in the Prevention and Control of Acute and Chronic Disease Khanassov, Pluye, & Vedel (McGill)