Barriers to Treatment: The Unique Challenges for Physicians Providing Dementia Care

Foster, Norman L.

doi:10.1177/089198870101400404

Cited by 22 publications

(11 citation statements)

References 46 publications

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“…Currently, the diagnostic process for a person with suspected cognitive decline is complex. Simple and specific diagnostic tests for dementing illnesses, such as Alzheimer's disease (AD), are not yet available, and patients present with widely varying symptoms [1, 2]. Furthermore the diagnosis of dementing illness in general and of specific forms of dementia in particular often depends on the exclusion of other possible causes of the patient's symptoms.…”

Section: Introductionmentioning

confidence: 99%

Physician Practice Patterns Associated with Diagnostic Evaluation of Patients with Suspected Mild Cognitive Impairment and Alzheimer’s Disease

Judge

Roberts

Khandker

et al. 2019

International Journal of Alzheimer's Disease

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The diagnostic process for patients presenting with cognitive decline and suspected dementia is complex. Physicians face challenges distinguishing between normal aging, mild cognitive impairment, Alzheimer’s disease, and other dementias. Although there is some evidence for improving attitudes towards the importance of prompt diagnosis, there is limited information describing how physicians approach this diagnostic challenge in practice. This was explored in the present study. Across-sectional survey of primary care and specialist physicians, in 5 European countries, Canada, and the United States, was conducted. Participants were asked about their use of cognitive screening tools and diagnostic technologies, as well as the rationales and barriers for use. In total, 1365 physicians participated in the survey, 63% of whom were specialists. Most physicians stated they use objective cognitive tools to aid the early detection of suspected mild cognitive impairment or Alzheimer’s disease in patients. The Mini-Mental State Examination was the most common tool used for initial screening; respondents cited speed and ease of use but noted its lack of specificity. Cerebrospinal fluid biomarker and amyloid positron emission tomography tests, respectively, had been used by only 26% and 32% of physicians in the preceding 6 months, although patterns of use varied across countries. The most commonly cited reasons for not ordering such tests were invasiveness (for cerebrospinal fluid biomarker testing) and cost (for amyloid positron emission tomography imaging). Data reported by physicians reveal differences in the approaches to the diagnostics process in Alzheimer’s. A higher proportion of primary care physicians in the United States are routinely incorporating cognitive assessment tools into annual visits, but this is due to country differences in clinical practice. The value of screening tools and regular use could be discussed further with physicians; however, lack of specificity associated with cognitive tools and the investment required from patients and the healthcare system are limiting factors.

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Section: Introductionmentioning

confidence: 99%

Physician Practice Patterns Associated with Diagnostic Evaluation of Patients with Suspected Mild Cognitive Impairment and Alzheimer’s Disease

Judge

Roberts

Khandker

et al. 2019

International Journal of Alzheimer's Disease

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“…19,20 Specialist dementia services, such as CDAMS, can assist with assessment expertise and treatment strategies but do not have sufficient resources to provide ongoing care and interventions; this role falls to the GP. Facilitating GPs' collaboration with the clinic is an important strategy for supporting GPs in their central role.…”

Section: Resultsmentioning

confidence: 99%

Cognitive dementia and memory service clinics: Opinions of general practitioners

Gardner¹,

Foreman

Davis

2004

Am J Alzheimers Dis Other Demen

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This study examined general practitioners' (GPs) satisfaction with services provided by memory clinics and the extent to which the clinics were seen as assisting with the management of their patients with dementia. Thirty-five GPs, who had recently referred patients to the Cognitive Dementia and Memory Service (CDAMS) in Victoria, Australia, were interviewed about their experiences. Overall, most were satisfied with the service the clinic provided. They were most positive about the completeness and utility of the assessment and diagnostic information provided, but relatively less satisfied with advice regarding the family's coping and community support services for the patient. It was concluded that the CDAMS is enhancing the capacity of GPs to provide ongoing care to people with dementia. However, the establishment of firmer communication and collaborative protocols between the clinics and GPs would improve their usefulness.

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“…Obstacles to detecting dementia at the primary care level include limited time resources [9][10][11][12][13], insufficient expertise, flaw in skill set, fear of making an erroneous diagnosis, unsatisfactory reimbursement, and deficiencies in the coordination between family physicians (henceforth called general practitioners (GPs)) and community services [14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

The Management of Dementia in Primary Care

Vreese¹,

Salvatore²,

Rovesta³

et al. 2016

Primary Care in Practice - Integration Is Needed

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High-quality in-home primary healthcare services are pivotal for people with dementia and their families to avoid inappropriate hospital admissions and premature nursing home placement, which are associated with worsened quality of life of both the person with dementia and his family and financial burden. This chapter gives a qualitative overview of the evidence on the efficacy and effectiveness of different primary care models covering all the stages of the disease from the onset of the disease until the more advanced stages with a particular focus on the management of behaviour and psychological disorders. A detailed description is provided of the primary care model of the Province of Modena for people with dementia and their families in which the general practitioner plays a central role both in the diagnostic process and in follow-up and closely collaborates with first-and second-level healthcare professionals. This "collaborative care" network is able to address timely the continuously changing needs of these frail people and their caregivers, including acute severe behavioural and psychological disorders. A 10-item composite indicator of appropriateness of care by the general practitioner has been recently introduced to further improve the quality of care within primary care.

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Barriers to Treatment: The Unique Challenges for Physicians Providing Dementia Care

Cited by 22 publications

References 46 publications

Physician Practice Patterns Associated with Diagnostic Evaluation of Patients with Suspected Mild Cognitive Impairment and Alzheimer’s Disease

Physician Practice Patterns Associated with Diagnostic Evaluation of Patients with Suspected Mild Cognitive Impairment and Alzheimer’s Disease

Cognitive dementia and memory service clinics: Opinions of general practitioners

The Management of Dementia in Primary Care

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