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.