Background: Heterogeneity in the assessment of individuals with dementia across memory clinics poses a significant challenge for standardizing practices and establishing interoperable clinical registries. The REMEMVER network in Chile, a collaborative public initiative supported by the Alzheimer's Association, seeks to address these challenges through the standardization of practices and the development of a Real-World Data registry for dementia in Latin America. To implement effective standardization and capacity-building strategies, it is vital to understand local capacities and factors influencing implementation. Therefore, identifying the structural capacities, gaps, and determinants that affect the harmonization of practices among the seven memory clinics participating in the REMEMVER network is essential.
Methods: We conducted a study that included surveys of local leaders and non-medical professionals, a Delphi process, and a participatory workshop with guided discussions and SWOT analysis. Using the CFIR (Consolidated Framework for Implementation Research) framework, we evaluated seven memory clinics to assess pilot implementation and inform scale-up, focusing on workforce capacity, infrastructure, assessment practices, clinical data systems, and implementation processes while considering sociocultural variations.
Results: Substantial variability was noted across clinics in a network of 56 professionals, serving 5,796 patients across 1,200 KM from Santiago to Castro. The teams mainly consisted of non-medical staff like speech therapists, occupational therapists, neuropsychologists, and social workers. Key structural gaps included a shortage of specialized human resources, infrastructure challenges affecting over 70% of centers, inconsistent assessment practices, and fragmented data systems. Sociocultural differences amplified this variability. Implementation challenges included data management gaps, misalignment among teams, resistance to change, and concerns about workload. Effective interoperability with hospital systems was identified as a crucial enabling factor.
Conclusion: Harmonization of memory clinic practices requires prioritizing structured, context-sensitive training as a foundational step, alongside alignment of organizational, technical, and contextual factors. Implementation efforts should focus on capacity building, the development of interoperable data systems, and sustained institutional support, while ensuring site-specific adaptations and coordinated network-level accompaniment. These findings support REMEMVER as a scalable model for dementia care in middle-income health systems.