A stakeholder-engaged process to design and implement the Assessment of Cognitive Complaints Toolkit for Alzheimer’s Disease (ACCT-AD) in primary care

Abstract

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. To describe the collaborative design process, developmental and feasibility testing, and lessons learned when creating a new cognitive assessment tool for primary care settings. 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 three community primary care practices in California. Primary Care Clinicians used the toolkit to assess 137 cases. Most found the toolkit helpful (94%) and endorsed moderate or high confidence in their diagnoses (99%). Factors impacting implementation of 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. 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.