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Sideman AB, Hernandez de Jesus A, Alagappan C, Ma M, Koenig CJ, Alving LI, Segal-Gidan F, Goldberger R, Sohmer D, Rosen H. Strengthening Primary Care Workforce Capacity in Dementia Diagnosis and Care: A Qualitative Study of Project Alzheimer's Disease-ECHO. Med Care Res Rev 2024:10775587241251868. [PMID: 38819958 DOI: 10.1177/10775587241251868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Primary care practitioners (PCPs) are the first point of contact for most patients with suspected dementia and have identified a need for more training and support around dementia diagnosis and care. This qualitative study examined the Alzheimer's Disease-Extension for Community Healthcare Outcomes (AD-ECHO) program. AD-ECHO was designed to strengthen PCP capacity in dementia through bimonthly virtual meetings with a team of dementia experts. We conducted 24 hr of direct observations at AD-ECHO sessions and interviewed 14 participants about their experiences participating. Using thematic analysis, we found that participants valued the supportive learning environment and resources; knowledge gained empowered them to take more action around dementia; they identified ways of disseminating knowledge gained into their practice settings, and many desired ongoing AD-ECHO engagement. However, most identified time as a barrier to participation. AD-ECHO has the potential to strengthen the primary care workforce's knowledge and confidence around dementia care.
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Affiliation(s)
| | | | | | - Melissa Ma
- University of California, San Francisco, USA
| | | | | | | | | | | | - Howie Rosen
- University of California, San Francisco, USA
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Bourque M, Foley T. Improving the Quality of Dementia Care in General Practice: A Qualitative Study. Front Med (Lausanne) 2020; 7:600586. [PMID: 33324664 PMCID: PMC7724029 DOI: 10.3389/fmed.2020.600586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
Background: General Practitioners (GPs) play a central role in caring for people with dementia. There is a growing demand for GP-led community-based dementia care, as advocated in the Irish National Dementia Strategy (INDS). However, there is a paucity of research exploring GPs' views on dementia care since publication of the INDS. The aim of this qualitative study is to develop a deeper understanding of how to improve the quality of dementia care in General Practice, explored from the perspective of Irish GPs. Methods: Semi-structured interviews were conducted with GPs. GPs who completed the “Dementia in Primary Care” CPD module at University College Cork in Ireland were purposively recruited. Interviews were audio-recorded, transcribed, and analyzed by thematic analysis. Results: 12 interviews were conducted with 7 female and 5 male participants. Experience in General Practice ranged from 3 to 32 years. Most GPs practiced in mixed urban-rural settings (n = 9) and had nursing home commitments (n = 8). The average interview length was 45 minutes. Six major themes emerged from the data set, including resourcing primary care, addressing disparities in secondary care, community-centered care as patient-centered care, linking a dementia network, universal access to care, and raising public awareness. Conclusion: GPs find dementia care to be a complex and challenging aspect of primary care. While education and training is advocated by GPs, service delivery must be reconfigured. This will necessitate adequate financial resourcing and the restructuring of community-based dementia care services.
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Affiliation(s)
- Meghan Bourque
- Department of General Practice, University College Cork, Cork, Ireland
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
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Laver K, Cations M, Radisic G, de la Perrelle L, Woodman R, Fitzgerald JA, Kurrle S, Cameron ID, Whitehead C, Thompson J, Kaambwa B, Hayes K, Crotty M. Improving adherence to guideline recommendations in dementia care through establishing a quality improvement collaborative of agents of change: an interrupted time series study. Implement Sci Commun 2020; 1:80. [PMID: 32984846 PMCID: PMC7513321 DOI: 10.1186/s43058-020-00073-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/10/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Non-pharmacological interventions including physical activity programmes, occupational therapy and caregiver education programmes have been shown to lead to better outcomes for people with dementia and their care partners. Yet, there are gaps between what is recommended in guidelines and what happens in practice. The aim of this study was to bring together clinicians working in dementia care and establish a quality improvement collaborative. The aim of the quality improvement collaborative was to increase self-reported guideline adherence to three guideline recommendations. METHODS Interrupted time series. We recruited health professionals from community, hospital and aged care settings across Australia to join the collaborative. Members of the collaborative participated in a start-up meeting, completed an online learning course with clinical and quality improvement content, formed a quality improvement plan which was reviewed by a team of experts, received feedback following an audit of their current practice and were able to share experiences with their peers. The primary outcome was self-reported adherence to their guideline recommendation of interest which was measured using checklists. Data were collected monthly over a period of 18 months, and the study used an interrupted time series design and multilevel Poisson regression analysis to evaluate changes in self-reported adherence. RESULTS A total of 45 health professionals (78% therapists) from different sites joined the collaborative and 28 completed all requirements. Data from 1717 checklists were included in the analyses. Over the duration of the project, there was a significant increase in clinician self-reported adherence to guideline recommendations with a 42.1% immediate increase in adherence (incidence rate ratio = 1.42; 95% confidence interval = 1.08-1.87; p = 0.012). CONCLUSION Health professionals working with people with dementia are interested in and willing to join a quality improvement collaborative with the goal of improving non-pharmacological aspects of care. Participation in the collaborative improved the quality of care for people with dementia as measured through self-reported adherence to guideline recommendations. Although there are challenges in implementation of guideline recommendations within dementia care, the quality improvement collaborative method was considered successful. A strength was that it equipped and empowered clinicians to lead improvement activities and allowed for heterogeneity in terms of service and setting. TRIAL REGISTRATION ACTRN12618000268246.
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Affiliation(s)
- Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Monica Cations
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Gorjana Radisic
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Lenore de la Perrelle
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Richard Woodman
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Janna Anneke Fitzgerald
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
- Griffith Business School, Griffith University, Gold Coast, Australia
| | - Susan Kurrle
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ian D. Cameron
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Jane Thompson
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kate Hayes
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
- Griffith Business School, Griffith University, Gold Coast, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
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Petrazzuoli F, Vinker S, Palmqvist S, Midlöv P, Lepeleire JD, Pirani A, Frese T, Buono N, Ahrensberg J, Asenova R, Boreu QF, Peker GC, Collins C, Hanževački M, Hoffmann K, Iftode C, Koskela TH, Kurpas D, Reste JYL, Lichtwarck B, Petek D, Schrans D, Soler JK, Streit S, Tatsioni A, Torzsa P, Unalan PC, van Marwijk H, Thulesius H. Unburdening dementia - a basic social process grounded theory based on a primary care physician survey from 25 countries. Scand J Prim Health Care 2020; 38:253-264. [PMID: 32720874 PMCID: PMC7470166 DOI: 10.1080/02813432.2020.1794166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To explore dementia management from a primary care physician perspective. DESIGN One-page seven-item multiple choice questionnaire; free text space for every item; final narrative question of a dementia case story. Inductive explorative grounded theory analysis. Derived results in cluster analyses. Appropriateness of dementia drugs assessed by tertiary care specialist. SETTING Twenty-five European General Practice Research Network member countries. SUBJECTS Four hundred and forty-five key informant primary care physician respondents of which 106 presented 155 case stories. MAIN OUTCOME MEASURES Processes and typologies of dementia management. Proportion of case stories with drug treatment and treatment according to guidelines. RESULTS Unburdening dementia - a basic social process - explained physicians' dementia management according to a grounded theory analysis using both qualitative and quantitative data. Unburdening starts with Recognizing the dementia burden by Burden Identification and Burden Assessment followed by Burden Relief. Drugs to relieve the dementia burden were reported for 130 of 155 patients; acetylcholinesterase inhibitors or memantine treatment in 89 of 155 patients - 60% appropriate according to guidelines and 40% outside of guidelines. More Central and Northern primary care physicians were allowed to prescribe, and more were engaged in dementia management than Eastern and Mediterranean physicians according to cluster analyses. Physicians typically identified and assessed the dementia burden and then tried to relieve it, commonly by drug prescriptions, but also by community health and home help services, mentioned in more than half of the case stories. CONCLUSIONS Primary care physician dementia management was explained by an Unburdening process with the goal to relieve the dementia burden, mainly by drugs often prescribed outside of guideline indications. Implications: Unique data about dementia management by European primary care physicians to inform appropriate stakeholders. Key points Dementia as a syndrome of cognitive and functional decline and behavioural and psychological symptoms causes a tremendous burden on patients, their families, and society. •We found that a basic social process of Unburdening dementia explained dementia management according to case stories and survey comments from primary care physicians in 25 countries. •First, Burden Recognition by Identification and Assessment and then Burden Relief - often by drugs. •Prescribing physicians repeatedly broadened guideline indications for dementia drugs. The more physicians were allowed to prescribe dementia drugs, the more they were responsible for the dementia work-up. Our study provides unique data about dementia management in European primary care for the benefit of national and international stakeholders.
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Affiliation(s)
- Ferdinando Petrazzuoli
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- CONTACT Ferdinando Petrazzuoli Center for Primary Health Care Research, Clinical Research Center, Lund University, Box 50332, Malmö202 13, Sweden
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, General Practice, University of Leuven, Leuven, Belgium
| | - Alessandro Pirani
- Family and Nursing Home Practice – Memory Clinic, Alzheimer’s Association “Francesco Mazzucca” Onlus, Ferrara, Italy
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Nicola Buono
- SNAMID (National Society of Medical Education in General Practice), Caserta, Italy
| | - Jette Ahrensberg
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark
| | - Radost Asenova
- Department of Urology and General Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Quintí Foguet Boreu
- Institut Universitari d’Investigació en Atenció Primària- IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Gülsen Ceyhun Peker
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | | | | | - Kathryn Hoffmann
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | | | | | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, Wroclaw, Poland
| | - Jean Yves Le Reste
- EA 7479 SPURBO. Department of General Practice, Université de Bretagne Occidentale, Brest, France
| | - Bjørn Lichtwarck
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Davorina Petek
- Department of Family medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Diego Schrans
- Department of Family Medicine and Primary, Health Care Ghent University, Ghent, Belgium
| | | | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Athina Tatsioni
- Department of Internal Medicine, General Medicine, Faculty of Medicine, University of Ioannina School of Health Sciences, Ioannina, Greece
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Pemra C. Unalan
- Department of Family Medicine, Marmara University Medical Faculty, Istanbul, Turkey
| | | | - Hans Thulesius
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
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Abstract
BACKGROUND Dementia in the elderly constitutes a growing challenge in healthcare worldwide, including Hungary. There is no previous report on the role of general practitioners in the management of dementia. AIM The purpose of the present study was to investigate the Hungarian general practitioners' attitude toward their patients living with dementia as well as dementia care. Our goal was also to assess their willingness and habits in assessing dementia. Additionally we wanted to explore the role of education about dementia, and its impact on their attitude in dementia management. METHODS As part of a large survey, a self-administered questionnaire was filled out voluntarily by 402 of general practitioners. According to our preset criteria, 277 surveys were selected for evaluation. Descriptive statistical analysis and Likert-scale analysis were performed. FINDINGS Half of the doctors (49.8%) indicated that they conducted a test to assess cognitive functions in case of suspicion. Among the respondents who did not assess, 50.0% of physicians cited lack of time as the main reason for not doing so and 14.4% of them had not proper knowledge of testing methods. The respondents most often mentioned feelings toward their patients with dementia, were regret (Likert-scale mean: 3.33), helplessness (3.28) and sadness (3.07). The majority of physicians thought the treatment of dementia was difficult (4.46). Most of the respondents (81.2%) indicated that in the past 2 years they had not participated in any training about dementia. Those practitioners who had participated in some form of education were less likely to feel helpless facing a patient with dementia, and education also determined their approach to dementia care.
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Yamaguchi Y, Greiner C, Ryuno H, Fukuda A. Dementia nursing competency in acute care settings: A concept analysis. Int J Nurs Pract 2019; 25:e12732. [DOI: 10.1111/ijn.12732] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/03/2019] [Accepted: 03/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Yuko Yamaguchi
- Department of Gerontological Nursing, Graduate School of Health SciencesKobe University Kobe Japan
| | - Chieko Greiner
- Department of Gerontological Nursing, Graduate School of Health SciencesKobe University Kobe Japan
| | - Hirochika Ryuno
- Department of Gerontological Nursing, Graduate School of Health SciencesKobe University Kobe Japan
| | - Atsuko Fukuda
- Department of Adult Nursing, Graduate School of Health SciencesKobe University Kobe Japan
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Porteri C, Albanese E, Scerri C, Carrillo MC, Snyder HM, Martensson B, Baker M, Giacobini E, Boccardi M, Winblad B, Frisoni GB, Hurst S. The biomarker-based diagnosis of Alzheimer's disease. 1-ethical and societal issues. Neurobiol Aging 2017; 52:132-140. [PMID: 28317644 DOI: 10.1016/j.neurobiolaging.2016.07.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 07/01/2016] [Accepted: 07/18/2016] [Indexed: 01/31/2023]
Abstract
There is great interest in the use of biomarkers to assist in the timely identification of Alzheimer's disease (AD) in individuals with mild symptoms. However, the inclusion of AD biomarkers in clinical criteria poses socioethical challenges. The Geneva Task Force for the Roadmap of Alzheimer's Biomarkers was established to deliver a systematic strategic research agenda (aka roadmap) to promote efficient and effective validation of AD biomarkers and to foster their uptake in clinical practice. In this article, we summarize the workshop discussion of the Geneva Task Force "ethical and societal issues" working group, which comprised bioethicists, clinicians, health economists, and representatives of those affected by AD. The working group identified the following key issues that need to be included in the roadmap: improving access to services through timely diagnosis, the need for a diagnostic research protocol before moving to clinical routine, recruitment in diagnostic research protocols in the absence of effective therapy, respect for the autonomy of the individual with mild cognitive impairment in information and consent process and the right not to know biomarkers results, need for counseling programs, disclosure of the diagnosis in a structured environment and the involvement of family members, health policies including the individuals' views and the protection of their interests, and the economic costs for society.
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Affiliation(s)
- Corinna Porteri
- Bioethics Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | - Emiliano Albanese
- Department of Psychiatry, WHO Collaborating Centre, University of Geneva, Switzerland
| | - Charles Scerri
- Department of Pathology, Faculty of Medicine & Surgery, University of Malta, Malta
| | - Maria C Carrillo
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Heather M Snyder
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | | | - Mark Baker
- National Institute for Health and Care Excellence, London, UK
| | - Ezio Giacobini
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals of Geneva, Switzerland
| | - Marina Boccardi
- Laboratory of Neuroimaging and Alzheimer's Epidemiology, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; LANVIE (Laboratory of Neuroimaging of Aging) - Department of Psychiatry, University of Geneva, Switzerland
| | - Bengt Winblad
- Division of Neurogeriatrics, Department NVS, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - Giovanni B Frisoni
- LANVIE (Laboratory of Neuroimaging of Aging) - Department of Psychiatry, University of Geneva, Switzerland; Memory Clinic - Department of Internal Medicine, University Hospitals of Geneva, Switzerland
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, Geneva University Medical School, Switzerland
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Exploring dementia management attitudes in primary care: a key informant survey to primary care physicians in 25 European countries. Int Psychogeriatr 2017; 29:1413-1423. [PMID: 28416036 DOI: 10.1017/s1041610217000552] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Strategies for the involvement of primary care in the management of patients with presumed or diagnosed dementia are heterogeneous across Europe. We wanted to explore attitudes of primary care physicians (PCPs) when managing dementia: (i) the most popular cognitive tests, (ii) who had the right to initiate or continue cholinesterase inhibitor or memantine treatment, and (iii) the relationship between the permissiveness of these rules/guidelines and PCP's approach in the dementia investigations and assessment. METHODS Key informant survey. SETTING Primary care practices across 25 European countries. SUBJECTS Four hundred forty-five PCPs responded to a self-administered questionnaire. Two-step cluster analysis was performed using characteristics of the informants and the responses to the survey. MAIN OUTCOME MEASURES Two by two contingency tables with odds ratios and 95% confidence intervals were used to assess the association between categorical variables. A multinomial logistic regression model was used to assess the association of multiple variables (age class, gender, and perceived prescription rules) with the PCPs' attitude of "trying to establish a diagnosis of dementia on their own." RESULTS Discrepancies between rules/guidelines and attitudes to dementia management was found in many countries. There was a strong association between the authorization to prescribe dementia drugs and pursuing dementia diagnostic work-up (odds ratio, 3.45; 95% CI 2.28-5.23). CONCLUSIONS Differing regulations about who does what in dementia management seemed to affect PCP's engagement in dementia investigations and assessment. PCPs who were allowed to prescribe dementia drugs also claimed higher engagement in dementia work-up than PCPs who were not allowed to prescribe.
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Examination of level of knowledge in Italian general practitioners attending an education session on diagnosis and management of the early stage of Alzheimer's disease: pass or fail? Int Psychogeriatr 2016; 28:1111-24. [PMID: 26817511 DOI: 10.1017/s1041610216000041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND We detected the general level of knowledge about the early diagnosis of Alzheimer's disease (AD) and subsequent care in general practitioners (GPs) from Southern Italy. We explored also the GP perception about their knowledge and training on diagnosis and management of AD. METHODS On a sample of 131 GPs, we administered two questionnaires: the GP-Knowledge, evaluating GPs' expertise about AD epidemiology, differential diagnosis, and available treatments, and the GP-QUestionnaire on Awareness of Dementia (GP-QUAD), assessing the GPs' attitudes, awareness, and practice regarding early diagnosis of dementia. RESULTS Specific screening tests or protocols to diagnose and manage dementia were not used by 53% of our GPs. The training on the recognition of early AD signs and symptoms was considered inadequate by 55% of the participants. Females were more likely to consider their training insufficient (58%) compared to males (53%). Female GPs were less likely to prescribe antipsychotic drugs to control neuropsychiatric symptoms (NPS) and suggest specialist advice in late stage of cognitive impairment. Multiple Correspondence Analysis (MCA) performed only on GP-QUAD suggested two dimensions explaining 26.1% ("GP attitude") and 20.1% ("GP knowledge") of the inertia for a total of 46.2%, CONCLUSION In our survey on GP clinical practice, several problems in properly recognizing early AD symptoms and subsequently screening patients to be referred to secondary/tertiary care centers for diagnosis confirmation have emerged. In the future, specific training programs and educational projects for GPs should be implemented also in Italy to improve detection rates and management of dementia in primary care.
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Spenceley SM, Sedgwick N, Keenan J. Dementia care in the context of primary care reform: an integrative review. Aging Ment Health 2015; 19:107-20. [PMID: 24901364 DOI: 10.1080/13607863.2014.920301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The purpose of this review was to determine the influence of the growing body of evidence about the attributes of high-performing primary care systems on the literature related to the primary care of people living with dementia. METHODS In this integrative review, we examined a broad range of published and grey literature (2000-2013) about the primary care of dementia, using a systematic approach set up in advance of the literature search. The review was guided by two questions: What are the evident models of primary care for dementia? How do the models line up with the other attributes of high-performing primary care? RESULTS Three models were noted: carved-out, co-managed, and integrative-hub, all informed by different assumptions about the role of primary care in dementia. The models varied in alignment with the attributes of high-performing primary care, although we found very little attention to accessibility, relational continuity or comprehensiveness of care. CONCLUSIONS We know what we need to pay attention to in building our primary care system - and no population will put the performance of primary care more to the test over the next two decades than the rapidly growing number of people who will be living with complex chronic conditions like dementia. Recent literature around primary care and dementia shows promise in attending to some of the attributes of high-performing primary care, yet much more work is needed if we are to truly leverage the potential value of primary care in addressing the needs of these complex and numerous future patients.
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Affiliation(s)
- Shannon M Spenceley
- a Faculty of Health Sciences (Nursing) , University of Lethbridge , Alberta , Canada
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11
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Kosteniuk JG, Morgan DG, O'Connell ME, Kirk A, Crossley M, Teare GF, Stewart NJ, Bello-Haas VD, Forbes DA, Innes A, Quail JM. Incidence and prevalence of dementia in linked administrative health data in Saskatchewan, Canada: a retrospective cohort study. BMC Geriatr 2015; 15:73. [PMID: 26135912 PMCID: PMC4489119 DOI: 10.1186/s12877-015-0075-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 06/16/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Determining the epidemiology of dementia among the population as a whole in specific jurisdictions - including the long-term care population-is essential to providing appropriate care. The objectives of this study were to use linked administrative databases in the province of Saskatchewan to determine the 12-month incidence and prevalence of dementia for the 2012/13 period (1) among individuals aged 45 and older in the province of Saskatchewan, (2) according to age group and sex, and (3) according to diagnosis code and other case definition criteria. METHODS We used a population-based retrospective cohort study design and extracted data from 10 provincial health databases linked by a unique health services number. The cohort included individuals 45 years and older at first identification of dementia between April 1, 2001 and March 31, 2013 based on case definitions met within any one of four administrative health databases (Hospital Discharge Abstracts, Physician Service Claims, Prescription Drug, and RAI-MDS, i.e., Long-term Care). RESULTS A total of 3,270 incident cases of dementia (7.28 per 1,000 PAR) and 13,012 prevalent cases (28.16 per 1,000 PAR) were identified during 2012/13. This study found the incidence rate increased by 2.8 to 5.1 times and the prevalence rate increased by 2.6 to 4.6 times every 10 years after 45 years of age. Overall, the age-standardised incidence rate was significantly lower among females than males (7.04 vs. 7.65 per 1,000 PAR) and the age-standardised prevalence rate was significantly higher among females than males (28.92 vs. 26.53 per 1,000 PAR). Over one-quarter (28 %) of all incident cases were admitted to long-term care before a diagnosis was formally recorded in physician or hospital data, and nearly two-thirds of these cases were identified at admission with impairment at the moderate to very severe level or a disease category of Alzheimer's disease/other dementia. CONCLUSIONS Linking multiple sources of registry data contributes to our understanding of the epidemiology of dementia across multiple segments of the population, inclusive of individuals residing in long-term care. This information is foundational for public awareness and policy recommendations, health promotion and prevention strategies, appropriate health resource planning, and research priorities.
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Affiliation(s)
- Julie G Kosteniuk
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, PO Box 23, 104 Clinic Place, Saskatoon, S7N 2Z4, SK, Canada.
| | - Debra G Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Andrew Kirk
- Division of Neurology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Margaret Crossley
- Department of Psychology (Professor Emerita), University of Saskatchewan, Saskatoon, SK, Canada.
| | - Gary F Teare
- Saskatchewan Health Quality Council, Saskatoon, SK, Canada.
| | - Norma J Stewart
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.
| | | | - Dorothy A Forbes
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
| | - Anthea Innes
- Bournemouth University Dementia Institute, Bournemouth University, Dorset, UK.
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Caruana-Pulpan O, Scerri C. Practices in diagnosis, disclosure and pharmacotherapeutic management of dementia by general practitioners--a national survey. Aging Ment Health 2014; 18:179-86. [PMID: 23869797 DOI: 10.1080/13607863.2013.819833] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To explore the practice patterns of general practitioners (GPs) for the diagnosis, disclosure and pharmacological management of individuals with dementia. We also investigated whether the number of years working in general practice is a determinant factor associated with the responses obtained. METHOD A national survey was sent to all registered GPs in the Maltese islands. The return rate was 54.2% with the majority of respondents having 15 years or more working experience in general practice. Chi-square analysis of variance was used to determine any relationship effects. RESULTS Although the majority of GPs indicated lack of competence in diagnosing dementia, only a small percentage showed a preference towards specialist referral. Lack of training was mostly envisaged by physicians with the least number of years in general practice. Significant differences in pharmacotherapeutic prescribing were noted depending on the stage of disease progression and the number of years working as a GP. Disease disclosure was not routinely carried out even though GPs were aware of the fact that disclosure may help individuals with dementia and their caregivers or relatives with future planning. CONCLUSION The findings show notable shortcomings in various aspects of dementia management by GPs. This highlights the need of providing continued educational support and training opportunities to enhance not only GPs' clinical competence, but also their role as key players in providing quality support to individuals with dementia in the primary care setting.
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Affiliation(s)
- Oana Caruana-Pulpan
- a Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery , University of Malta , Msida , Malta
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Somme D, Gautier A, Pin S, Corvol A. General practitioner's clinical practices, difficulties and educational needs to manage Alzheimer's disease in France: analysis of national telephone-inquiry data. BMC FAMILY PRACTICE 2013; 14:81. [PMID: 23763854 PMCID: PMC3682915 DOI: 10.1186/1471-2296-14-81] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 06/11/2013] [Indexed: 01/24/2023]
Abstract
Background The literature has emphasized the role of general practitioners (GPs) in caring for Alzheimer’s disease (AD) patients. Within the framework of the French national AD plan, an inquiry was undertaken to identify the clinical practices, difficulties and training needs of GPs managing this pathology. Methods A random sample from a representative national listing of continental French GPs following ≥1 AD patients comprised the study population. Participants completed a standard questionnaire on their clinical practices, difficulties and educational needs for AD management. Feeling insufficiently trained was subjected to univariate and multivariate analyses. Results A minority of the 974 respondents declared using questionnaires in their diagnostic evaluation (15.2%), told the patient the diagnosis (8.2%) and was aware of the national recommendations for AD (41.9%). Behavioral disorders represented the most common (73.5%) problem encountered, while half of the GPs considered management of comorbidities easy roles to fulfill. In comparison, coordination of care and assistance did not seem to be a primary problem. A score was calculated, attributing 1 point to each of the following items: need for further education in terms of communications with the family, with patients, disclosing the diagnosis, and non-drug treatments. The factors linked to feeling insufficiently trained for 3 or 4 of the 4 items were: female sex; not involved in educational programs (for parents/family and patients) and no activity related to training medical students. Conclusions Our study identified gaps in French GP training concerning AD diagnosis practices and diagnosis announcement. GPs seemed aware of their educational needs and described difficulties in managing behavioral disorders. Our findings enabled the definition of policy priorities to provide training and disseminate information.
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Moore V, Cahill S. Diagnosis and disclosure of dementia--a comparative qualitative study of Irish and Swedish General Practitioners. Aging Ment Health 2013; 17:77-84. [PMID: 22690732 DOI: 10.1080/13607863.2012.692763] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To explore the attitudes of Irish and Swedish General Practitioners (GPs) to the diagnosis and disclosure of dementia to patients; to investigate GP under-graduate/post-graduate training in dementia; to examine the post-diagnostic support services available to GPs in both countries and to investigate the extent to which dementia is perceived as stigmatising. METHODS A cross-national exploratory qualitative design was used. In-depth interviews were conducted with five Irish and four Swedish GPs. Interviews were transcribed, translated, thematically coded and categorised. RESULTS Both Irish and Swedish GPs unequivocally considered the early diagnosis of dementia important but neither group was proactive in making a diagnosis. Both groups relied heavily on family members or patients to bring to their attention memory loss and cognitive impairment problems. Most GPs reported a reluctance to diagnose and several acknowledged going to considerable lengths to avoid using the word 'dementia'. The Swedish GPs had more exposure to dementia-specific training, saw the value in training and were generally very satisfied with post-diagnostic dementia services available to patients, while Irish GPs were less likely to have undergone training, were more equivocal about its value and were very dissatisfied with the community services available. CONCLUSION Despite the presence of very adequate post-diagnostic support services for people recently diagnosed with dementia, the majority of Swedish GPs like their Irish counterparts displayed therapeutic nihilism and were reluctant to speak overtly to their patients about their dementia. Dementia continues to be a stigmatising illness for both Irish and Swedish GPs.
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Affiliation(s)
- Vanessa Moore
- Living with Dementia Research Program, School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland.
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