학술논문

Dementia assessment and management in primary care settings: a survey of current provider practices in the United States
Document Type
article
Source
BMC Health Services Research. 19(1)
Subject
Health Services and Systems
Health Sciences
Biomedical Imaging
Acquired Cognitive Impairment
Behavioral and Social Science
Neurosciences
Health Services
Clinical Research
Brain Disorders
4.2 Evaluation of markers and technologies
Detection
screening and diagnosis
7.3 Management and decision making
Management of diseases and conditions
Neurological
Cross-Sectional Studies
Dementia
Humans
Neurologic Examination
Practice Patterns
Physicians'
Primary Health Care
Referral and Consultation
United States
Primary care
Neurocognitive disorders
Diagnosis
Care management
Library and Information Studies
Nursing
Public Health and Health Services
Health Policy & Services
Health services and systems
Public health
Language
Abstract
BACKGROUND:Primary care providers (PCPs) are typically the first to screen and evaluate patients for neurocognitive disorders (NCDs), including mild cognitive impairment and dementia. However, data on PCP attitudes and evaluation and management practices are sparse. Our objective was to quantify perspectives and behaviors of PCPs and neurologists with respect to NCD evaluation and management. METHODS:A cross-sectional survey with 150 PCPs and 50 neurologists in the United States who evaluated more than 10 patients over age 55 per month. The 51-item survey assessed clinical practice characteristics, and confidence, perceived barriers, and typical practices when diagnosing and managing patients with NCDs. RESULTS:PCPs and neurologists reported similar confidence and approaches to general medical care and laboratory testing. Though over half of PCPs performed cognitive screening or referred patients for cognitive testing in over 50% of their patients, only 20% reported high confidence in interpreting results of cognitive tests. PCPs were more likely to order CT scans than MRIs, and only 14% of PCPs reported high confidence interpreting brain imaging findings, compared to 70% of specialists. Only 21% of PCPs were highly confident that they correctly recognized when a patient had an NCD, and only 13% were highly confident in making a specific NCD diagnosis (compared to 72 and 44% for neurologists, both p