“I think we can definitely develop a model, not only for COPD but [for] multiple chronic issues to be done in a similar fashion as we do memory”

“It has been an enlightening experience working with the memory clinic team and [it] provides an excellent basis to deal with other chronic issues. I will support any initiative based on the memory clinic model”

“Memory clinics and similar models apply well to care of frail, complex seniors because it places their care where it belongs—in primary care”

“If you have a cardiorespiratory-type clinic, that would be kind of ideal for a memory clinic setting because you can look at all the factors …. A lot of patients that we see have COPD, they have congestive heart failure, they have a bit of renal failure, maybe a little bit of coronary disease, and so creating a clinic to take all of that together is equally valuable”

“From the health point of view [the expanded clinic model] would reduce hospital admission [and] reduce ER visits. It would, I think, from the ledger sheet point of view, make sense”

“Well, it’s really well known that if we can give better complex care to our seniors there [are] going to be fewer medication errors, there [are] going to be fewer times they enter the hospital setting, [and they will be] less likely to break their hips [and] less likely to be confused”

“Hopefully it will be better care for patients—that they were actually going to get more comprehensive care and better care, which then hopefully ... will translate into a better quality of life for the patient. Less [emergency department] trips, less hospitalizations, or shorter hospitalizations”

“I think that expanding the memory clinic model would reduce wait times, reduce acute care, and be cost effective if there was adequate remuneration for physicians and funding for appropriate training and staffing”

“I think we would need more training regarding issues of frailty ... how do we in the different domains pull that information together? [We need] a little bit more didactic information on that and how we approach it and manage it with more training”

“Working in a team makes a big difference ... such as access to an OT for patients with high risk of falls and a social worker for the family support complex vulnerable patients require”

“Working with the memory clinic and the training that we have had and the support from specialists has been exciting and rewarding in a way that is all too unusual in general practice. It is very much a ‘win-win’ model— patients and their families, allied health team members, physicians, and the health care system in general”

“The lack of time can be quite difficult if the patient comes in and they’re frail, they’re living maybe alone, they have a lack of support .... Multiple scenarios that come along in terms of COPD and CHF management ... polypharmacy becomes a big concern … those are usually the sort of bigger concerns because they rarely do come in with just one simple concern, they come in with a few that [are] interrelated. So the time sometimes makes it difficult in a standard visit”

“Without the supports, even with a nice consult and package and things ... I could see that it would be a big challenge to keep that exceptional care of their comorbidities at a high level without the system [enhancements]”

“Family doctors are not equipped. They don’t have the time [and] they don’t have the resources at the facility. So if we have the team, if the resources are there, if we are trained to be able to do the assessment, then yes, definitely, there’s a benefit to [the expanded model]”

“In the case of NPs and social workers ... they are attached to a specific site, so for the time that they are spending in the clinic ... the site is without an [NP] or social worker because they are in a clinic elsewhere. So maybe having to staff a clinic would be very helpful”

“Do I particularly think I was compensated based on how much involvement and how much we were doing? I’m not sure that the compensation was great”

“If we started doing lots more ... types of clinics then I would have to start to weigh the pros and cons of how much my satisfaction actually played into being able to tolerate [a] decreased salary”

“Family physicians have always looked after frail, complex seniors with multiple morbidities. Newer primary reform funding does reward health maintenance but does not reward looking after complex frail seniors”