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

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.