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Rojas-Rozo L, Lee L, Khanassov V, Sivananthan S, Ismail Z, Gauthier S, Vedel I. Latest Canadian Consensus Conference on the Diagnosis and Treatment of Dementia: What's in It for Primary Care? Can J Aging 2024; 43:185-196. [PMID: 37855225 DOI: 10.1017/s0714980823000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
In 2020, the fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5) published up-to-date recommendations for the clinical management of persons living with dementia (PLWD) and their caregivers. During the CCCDTD5 meetings, a list of recommendations for dementia care was compiled. With the aid of family physicians and the Canadian Consortium on Neurodegeneration in Aging, we selected the most relevant CCCDTD5 recommendations for primary care and tailored and summarized them in the present manuscript to facilitate their reference and use. These recommendations focus on (a) risk reduction, (b) screening and diagnosis, (c) deprescription of dementia medications, and (d) non-pharmacological interventions. The development of recommendations for the ongoing management of dementia is an iterative process as new evidence on interventions for dementia is published. These recommendations are important in the primary care setting as the entry point for PLWD into the health system.
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Affiliation(s)
- Laura Rojas-Rozo
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Serge Gauthier
- Departments of Neurology and Neurosurgery, and Psychiatry, McGill University, Montreal, QC, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
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Arsenault-Lapierre G, Lemay-Compagnat A, Guillette M, Couturier Y, Massamba V, Dufour I, Maubert E, Fournier C, Denis J, Morin C, Vedel I. Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations. JMIR Form Res 2024; 8:e55064. [PMID: 38717803 PMCID: PMC11112472 DOI: 10.2196/55064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Health organizations face the critical task of executing and overseeing comprehensive health care. To address the challenges associated with this task, evidence-based dashboards have emerged as valuable tools. Since 2016, the regional health organizations of Quebec, Canada, have been responsible for ensuring implementation of the Quebec Alzheimer Plan (QAP), a provincial plan that aims to reinforce the capacity of primary care services to detect, diagnose, and treat persons with dementia. Despite the provincial scope of the QAP, the diverse material and human resources across regions introduce variability in the interest, utility, and specific needs associated with these dashboards. OBJECTIVE The aim of this study was to assess the interest and utility of dashboards to support the QAP implementation, as well as to determine the needs for improving these aspects according to the perspectives of various types of professionals involved across regions. METHODS An evaluative study using qualitative methods was conducted within a collaborative research approach involving different stakeholders, including the ministerial advisor and the four project managers responsible for supporting the implementation of the QAP, as well as researchers/scientific advisors. To support these organizations, we developed tailored, 2-page paper dashboards, detailing quantitative data on the prevalence of dementia, the use of health services by persons with dementia, and achievements and challenges of the QAP implementation in each organization's jurisdiction. We then conducted 23 focus groups with the managers and leading clinicians involved in the implementation of the QAP of each regional health organization. Real-time notes were taken using a structured observation grid. Content analysis was conducted according to different regions (organizations with university mandates or nearby organizations, labeled "university/peripheral"; organizations for which only part of the territory is in rural areas, labeled "mixed"; and organizations in remote or isolated areas, labeled "remote/isolated") and according to different types of participants (managers, leading clinicians, and other participants). RESULTS Participants from organizations in all regions expressed interest in these dashboards and found them useful in several ways. However, they highlighted the need for indicators on orphan patients and other health care providers. Differences between regions were observed, particularly in the interest in continuity of care in university/peripheral regions and the need for diagnostic tools adapted to the culture in remote/isolated regions. CONCLUSIONS These dashboards support the implementation of an Alzheimer Plan and contribute to the emergence of a learning health care system culture. This project allows each region to increase its monitoring capacity for the implementation of the QAP and facilitates reflection among individuals locally carrying out the implementation. The perspectives expressed will guide the preparation of the next iteration of the dashboards.
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Affiliation(s)
- Genevieve Arsenault-Lapierre
- Center for Research and Expertise in Social Gerontology, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, Côte Saint-Luc, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra Lemay-Compagnat
- Lady Davis Institute for Medical Research, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, Montreal, QC, Canada
| | - Maxime Guillette
- Department of Social Work, Sherbrooke University, Sherbrooke, QC, Canada
| | - Yves Couturier
- Department of Social Work, Sherbrooke University, Sherbrooke, QC, Canada
| | | | - Isabelle Dufour
- School of Nursing, Sherbrooke University, Sherbrooke, QC, Canada
- Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Eric Maubert
- Integrated University Health and Social Services Network of McGill University, Montreal, QC, Canada
| | - Christine Fournier
- Integrated University Health and Social Services Network of Université de Montréal, Montreal, QC, Canada
| | - Julie Denis
- Integrated University Health and Social Services Network of Université Laval, Quebec, QC, Canada
| | - Caroline Morin
- Integrated University Health and Social Services Network of Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, Montreal, QC, Canada
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Gaster B, Suchsland MZ, Fitzpatrick AL, Liao JM, Belza B, Hsu AP, McKiddy S, Park C, Olivari BS, Singh AP, Raetz J. Evaluating Cognitive Impairment in a Large Health Care System: The Cognition in Primary Care Program. J Alzheimers Dis 2024; 99:493-501. [PMID: 38701141 DOI: 10.3233/jad-231200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background The prevalence of Alzheimer's disease and related disorders (ADRD) is rising. Primary care providers (PCPs) will increasingly be required to play a role in its detection but lack the training to do so. Objective To develop a model for cognitive evaluation which is feasible in primary care and evaluate its implementation in a large health system. Methods The Cognition in Primary Care Program consists of web-based training together with integrated tools built into the electronic record. We implemented the program among PCPs at 14 clinics in a large health system. We (1) surveyed PCPs to assess the impact of training on their confidence to evaluate cognition, (2) measured the number of cognitive assessments they performed, and (3) tracked the number of patients diagnosed with mild cognitive impairment (MCI). Results Thirty-nine PCPs completed the training which covered how to evaluate cognition. Survey response rate from those PCPs was 74%. Six months after the end of the training, they reported confidence in assessing cognition (mean 4.6 on 5-point scale). Cognitive assessments documented in the health record increased from 0.8 per month before the training to 2.5 in the six months after the training. Patients who were newly diagnosed with MCI increased from 4.2 per month before the training to 6.0 per month in the six months after the training. Conclusions This model for cognitive evaluation in a large health system was shown to increase cognitive testing and increase diagnoses of MCI. Such improvements are essential for the timely detection of ADRD.
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Affiliation(s)
- Barak Gaster
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Joshua M Liao
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Basia Belza
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Amy P Hsu
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Sarah McKiddy
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Christina Park
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Benjamin S Olivari
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angad P Singh
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Jaqueline Raetz
- Department of Family Medicine, University of Washington, Seattle, WA, USA
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Paul P, Mahfoud ZR, Malik RA, Kaul R, Muffuh Navti P, Al-Sheikhly D, Chaari A. Knowledge, Awareness, and Attitude of Healthcare Stakeholders on Alzheimer's Disease and Dementia in Qatar. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4535. [PMID: 36901551 PMCID: PMC10002196 DOI: 10.3390/ijerph20054535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Dementia is characterized by progressive cognitive decline, memory impairment, and disability. Alzheimer's disease (AD) accounts for 60-70% of cases, followed by vascular and mixed dementia. Qatar and the Middle East are at increased risk owing to aging populations and high prevalence of vascular risk factors. Appropriate levels of knowledge, attitudes, and awareness amongst health care professionals (HCPs) are the need of the hour, but literature indicates that these proficiencies may be inadequate, outdated, or markedly heterogenous. In addition to a review of published quantitative surveys investigating similar questions in the Middle East, a pilot cross-sectional online needs-assessment survey was undertaken to gauge these parameters of dementia and AD among healthcare stakeholders in Qatar between 19 April and 16 May 2022. Overall, 229 responses were recorded between physicians (21%), nurses (21%), and medical students (25%), with two-thirds from Qatar. Over half the respondents reported that >10% of their patients were elderly (>60 years). Over 25% reported having contact with >50 patients with dementia or neurodegenerative disease annually. Over 70% had not undertake related education/training in the last 2 years. The knowledge of HCPs regarding dementia and AD was moderate (mean score of 5.3 ± 1.5 out of 7) and their awareness of recent advances in basic disease pathophysiology was lacking. Differences existed across professions and location of respondents. Our findings lay the groundwork for a call-to-action for healthcare institutions to improve dementia care within Qatar and the Middle East region.
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Affiliation(s)
| | - Ziyad Riyad Mahfoud
- Division of Medical Education, Weill Cornell Medicine-Qatar, Doha 24144, Qatar
- Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, NY 10065, New York, USA
| | - Rayaz A. Malik
- Division of Medicine, Weill Cornell Medicine-Qatar, Doha 24144, Qatar
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9NT, UK
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M15 6BH, UK
| | | | - Phyllis Muffuh Navti
- Division of Continuing Professional Development, Weill Cornell Medicine-Qatar, Doha 24144, Qatar
| | - Deema Al-Sheikhly
- Division of Medical Education, Weill Cornell Medicine-Qatar, Doha 24144, Qatar
- Division of Continuing Professional Development, Weill Cornell Medicine-Qatar, Doha 24144, Qatar
| | - Ali Chaari
- Premedical Division, Weill Cornell Medicine-Qatar, Doha 24144, Qatar
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Abdalrahim A, Alamoush KM, ALBashtawy M, Hamaideh SH, Mohammad KI, Alkhawaldeh A, Alazzam M, Alhroub N, Suliman M, ALBashtawy B. Jordanian Community People's Knowledge of and Attitudes Toward Dementia. SAGE Open Nurs 2023; 9:23779608231201052. [PMID: 37705733 PMCID: PMC10496485 DOI: 10.1177/23779608231201052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/13/2023] [Accepted: 08/27/2023] [Indexed: 09/15/2023] Open
Abstract
Introduction Limited research exists on the knowledge and attitudes of Jordanian community residents toward people with dementia (PwD). As the prevalence of dementia is anticipated to increase, there is a critical need for informed knowledge and positive attitudes toward dementia in the Jordanian community. Objectives This study aimed to evaluate people's knowledge of and attitudes toward PwD and identify the predictors of dementia knowledge and attitudes. Methods The study employed a cross-sectional research design and utilized a self-administered questionnaire as the primary data collection method. The study employed the Alzheimer's Disease Knowledge Scale (ADKS) to evaluate the knowledge of the participants, and the Dementia Attitudes Scale (DAS) was utilized to assess their attitudes in the Jordanian community. Multiple regression analysis was performed to find relevant factors influencing knowledge of and attitude toward dementia. Results The study's 346 participants revealed limited knowledge about dementia, with an average ADKS score of 17.21 out of 30. However, participants showed a positive attitude toward dementia, as evidenced by a mean DAS score of 88 out of 140. Statistical analysis demonstrated significantly higher knowledge scores among employed individuals (P < .05), while females exhibited significantly higher attitude scores (P < .05). Participants with experience in geriatric clinical practice, dementia education or training, informal caregiving experience, and a desire to learn more about dementia also exhibited significantly higher knowledge and attitude scores (P < .05). Conclusion The study offers preliminary insights into the knowledge and attitudes toward dementia in the Jordanian population. The findings underscore the importance of continuing education and training to increase knowledge and understanding of dementia. Improving dementia care and support in Jordan requires enhancing knowledge and attitudes toward dementia. The study findings were presented to policymakers, with recommendations for strategic planning and the development of awareness programs. Future research can build upon these findings and promote evidence-based practices in dementia care and community awareness programs.
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Affiliation(s)
- Asem Abdalrahim
- Department of Community and Mental Health, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | | | - Mohammed ALBashtawy
- Department of Community and Mental Health, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Shaher H. Hamaideh
- Community and Mental Health Nursing Department, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Khitam Ibrahem Mohammad
- Department of Midwifery, Faculty of Nursing, University of Science &Technology, Irbid, Jordan
| | - Abdullah Alkhawaldeh
- Department of Community and Mental Health, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Manar Alazzam
- Department of Community and Mental Health, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | | | - Mohammad Suliman
- Department of Community and Mental Health, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Bayan ALBashtawy
- Jordan Ministry of Health, Bachelor of Medicine and Surgery, Irbid, Jordan
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Saposnik G, Ismail Z, Rivard AM, Knifton D, Bromfield G, Terzaghi M, Montoya A, Menard MC. Decision making under uncertainty in the diagnosis and management of Alzheimer's Disease in primary care: A study protocol applying concepts from neuroeconomics. Front Med (Lausanne) 2022; 9:997277. [DOI: 10.3389/fmed.2022.997277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe current management of patients with Dementia, primarily with Alzheimer's Disease (AD) is rapidly evolving. However, limited information is available about the current gaps and decision-making in primary care.ObjectivesTo evaluate factors associated with gaps, risk preferences regarding diagnostic and therapeutic choices in the management of patients with AD by primary care physicians (PCP) from across Canada.MethodsWe propose a non-interventional, cross-sectional pilot study involving 120 primary care physicians referred from the College of Family Physicians of Canada to assess diagnostic and therapeutic decisions in the management of ten simulated AD-related case-scenarios commonly encountered in clinical practice. We initially describe the current landscape and gaps regarding diagnostic and therapeutic challenges in the management of patients with AD in primary care. Then, we provide concepts from behavioral economics and neuroeconomics applied to medical decision-making. Specifically, we include standardized tests to measure risk aversion, physicians' reactions to uncertainty, and questions related to risk preferences in different domains. Finally, we summarize the protocol to be implemented to address our goals. The primary study outcome is the proportion of participants that elect to defer initial investigations to the specialist and the associated factors. Secondary outcomes include the proportion of PCP willing to order cerebral spinal fluid studies, PET scans, or initiate treatment according to the simulated case-scenarios. The study will be conducted in English and French.ConclusionsThe study findings will contribute a better understanding of relevant factors associated with diagnostic and therapeutic decisions of PCP in the management of AD, identifying participant's preferences and evaluating the role of behavioral aspects such tolerance to uncertainty, aversion to ambiguity, and therapeutic inertia.
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Arsenault-Lapierre G, Le Berre M, Rojas-Rozo L, McAiney C, Ingram J, Lee L, Vedel I. Improving dementia care: insights from audit and feedback in interdisciplinary primary care sites. BMC Health Serv Res 2022; 22:353. [PMID: 35300660 PMCID: PMC8931981 DOI: 10.1186/s12913-022-07672-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Many primary care sites have implemented models to improve detection, diagnosis, and management of dementia, as per Canadian guidelines. The aim of this study is to describe the responses of clinicians, managers, and staff of sites that have implemented these models when presented with audit results, their insights on the factors that explain their results, their proposed solutions for improvement and how these align to one another. Methods One audit and feedback cycle was carried out in eight purposefully sampled sites in Ontario, Canada, that had previously implemented dementia care models. Audit consisted of a) chart review to assess quality of dementia care indicators, b) questionnaire to assess the physicians’ knowledge, attitudes and practice toward dementia care, and c) semi-structured interviews to understand barriers and facilitators to implementing these models. Feedback was given to clinicians, managers, and staff in the form of graphic and oral presentations, followed by eight focus groups (one per site). Discussions revolved around: what audit results elicited more discussion from the participants, 2) their insights on the factors that explain their audit results, and 3) solutions they propose to improve dementia care. Deductive content and inductive thematic analyses, grounded in causal pathways models’ theory was performed. Findings The audit and feedback process allowed the 63 participants to discuss many audit results and share their insights on a) organizational factors (lack of human resources, the importance of organized links with community services, clear roles and support from external memory clinics) and b) clinician factors (perceived competency practice and attitudes on dementia care), that could explain their audit results. Participants also provided solutions to improve dementia care in primary care (financial incentives, having clear pathways, adding tools to improve chart documentation, establish training on dementia care, and the possibility of benchmarking with other institutions). Proposed solutions were well aligned with their insights and further nuanced according to contextual details. Conclusions This study provides valuable information on solutions proposed by primary care clinicians, managers, and staff to improve dementia care in primary care. The solutions are grounded in clinical experience and will inform ongoing and future dementia strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07672-5.
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Affiliation(s)
- Geneviève Arsenault-Lapierre
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada. .,Lady Davis Institute for Medical Research, Jewish General Hospital, Quebec, Montreal, Canada.
| | - Mélanie Le Berre
- Lady Davis Institute for Medical Research, Jewish General Hospital, Quebec, Montreal, Canada
| | - Laura Rojas-Rozo
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Carrie McAiney
- School of Public Health and Health Systems, University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Jennifer Ingram
- Kawartha Centre - Redefining Healthy Aging, and Senior Care Network, Central East Ontario, Peterborough, Ontario, Canada
| | - Linda Lee
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada.,Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Quebec, Montreal, Canada
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Correction. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:883. [PMID: 34906931 PMCID: PMC8670646 DOI: 10.46747/cfp.6712883_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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