The number of US older adults with dementia is expected to grow over the next several decades. For instance, the number of persons with Alzheimer disease is predicted to increase by 50% by 2030. Physicians commonly come into contact with patients who have dementia and, as such, need to understand its varied presentation. In the current review, the most common types of dementia, including Alzheimer disease, frontotemporal dementia, dementia due to vascular disease, and several others, are described. Characteristics and etiologic findings of cortical and subcortical dementias are differentiated, and cognitive profiles and symptoms of specific types of dementia are reviewed. An osteopathic approach to care, focusing on establishing a relationship with patients and their families, is also discussed.

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Purpose: The sociopolitical determinants of health drive health outcomes and inequities in the United States. Primary care practices are, increasingly, expected by payers and policy makers to assess patients’ social needs. Resource referral platforms provide physicians with information and referral systems for community resources. One commonly used platform is Aunt Bertha/Find Help (AB/FH). The American Academy of Family Physicians (AAFP) Neighborhood Navigator (NN) tool allows physicians and laypeople to search for resources using AB/FH. We sought to describe what users were searching for and to identify patterns to inform resource allocation. Methods: This was a descriptive study of the AAFP’s NN tool. Searches of NN were analyzed to describe what users were searching for. Results: From 2018 to April 2022 there were 168 135 searches. The most common searches were for food and housing insecurity (22%, 21%) and health care referral (20.6%) with 22% more searches in the winter than the spring. There was a 119% increase in searches between 2018 and 2022, and a 47% increase in searches during the COVID-19 Pandemic. In the “Health” category the top 20 subcategories accounted for over 77% of searches. Conclusions: Family physicians and their patients use NN to search AB/FH for community resources to address adverse social determinants of health (SDOH). As expected, searches increased during the COVID-19 pandemic. This type of analysis may help individual clinicians, practices, and health systems prepare for the most common social needs of their patients. Social resource platforms might serve as a robust measure for primary care practice screening and referral for SDOH.

Introduction: Primary care clinicians are presented with hundreds of new clinical recommendations and guidelines. To consider practice change clinicians must identify relevant information and develop a contextual framework. Too much attention to information irrelevant to one’s practice results in wasted resources. Too little results in care gaps. A small group of primary care clinicians in a large health system sought to address the problem of vetting new information and providing peer reviewed context. This was done by engaging colleagues across the system though a primary care learning collaborative. Methods: The collaborative was a grass roots initiative between community and academic-based clinicians. They invited all the system’s primary care clinicians to participate. They selected new recommendations or guidelines and used surveys as the principal communication instrument. Surveys shared practice experience and also invited members to give narrative feedback regarding their acceptance of variation in care relate to the topic. A description of the collaborative along with its development, processes, and evolution are discussed. Process changes to address needs during the COVID-19 pandemic including expanded information sharing was necessary. Results: Collaborative membership reached across 5 states and included family medicine, internal medicine, and pediatrics. Members found involvement with the collaborative useful. Less variation in care was thought important for public health crises: the COVID pandemic and opioid epidemic. Greater practice variation was thought acceptable for adherence to multispecialty guidelines, such as diabetes, lipid management, and adult ADHD care. Process changes during the pandemic resulted in more communications between members to avoid practice gaps. Conclusion: An internet-based learning collaborative in a health system had good engagement from its members. Using novel methods, it was able to provide members with feedback related to the importance of new practice recommendations as perceived by their peers. Greater standardization was thought necessary when adopting measures to address public health crisis, and less necessary when addressing multispecialty guidelines. By employing a learning collaborative, this group was able to keep members interested and engaged. During the first year of the COVID pandemic the collaborative also served as a vehicle to share timely information.

Background: In spring 2021, outbreaks of new variants of SARS-CoV-2 and vaccine resistance disrupted hopes that the pandemic was waning. New cases overwhelmed inpatient services, often shifting care of very ill patients to outpatient services. Methods: A primary care learning collaborative within a large health system conducted a member survey to study the impact of the pandemic on workload demands during winter 2021-2022. Members were asked about their experience with very ill patients in the outpatient setting and whether their ability to admit or transfer patients was impacted. Survey recipients were asked to rate the importance of planning for future unexpected medical crises. Results: 192 surveys were sent, 85(42%) responded. Of the 79 providing Primary Care outpatient services, nearly 1/3 reported a slight to significant increase in patient acuity. This was more pronounced in rural practices (44%) compared to those in non-rural practices (35%; OR= 1.29). 86% reported caring for very ill patients in the office in the two weeks preceding the survey, with 26% caring for 6 or more. Clinicians reported caring for the following problems: cardiovascular (76%), respiratory (47%), infectious disease (41%), gastrointestinal (26%) and mental health (26%). They reported difficulty admitting patients (76%), transferring patients (86%), prolonged emergency room stays (70%), and difficulty transferring to long term care (80%), without variation by hospital type (tertiary, secondary, critical access). Overall, 69% of members ranked the question on the importance of future preparation from 8-10, however, those in urban areas were less likely than their peers to do so (64% v 72%; OR 0.89). Discussion: During the COVID surge of 2021-2022 overwhelmed inpatient units, often a safety net for the very ill, shifted care back to outpatient management. Together, these elements served to further stress an already overworked primary care system.