Primary care physician volume and quality of care for older adults with dementia: a retrospective cohort study

Abstract

Background Some jurisdictions restrict primary care physicians’ daily patient volume to safeguard quality of care for complex patients. Our objective was to determine whether people with dementia receive lower-quality care if their primary care physician sees many patients daily. Methods Population-based retrospective cohort study using health administrative data from 100,256 community-living adults with dementia aged 66 years or older, and the 8,368 primary care physicians who cared for them in Ontario, Canada. Multivariable Poisson GEE regression models tested whether physicians’ daily patient volume was associated with the adjusted likelihood of people with dementia receiving vaccinations, prescriptions for cholinesterase inhibitors, benzodiazepines, and antipsychotics from their primary care physician. Results People with dementia whose primary care physicians saw ≥ 30 patients daily were 32% (95% CI: 23% to 41%, p < 0.0001) and 25% (95% CI: 17% to 33%, p < 0.0001) more likely to be prescribed benzodiazepines and antipsychotic medications, respectively, than patients of primary care physicians who saw < 20 patients daily. Patients were 3% (95% CI: 0.4% to 6%, p = 0.02) less likely to receive influenza vaccination and 8% (95% CI: 4% to 13%, p = 0.0001) more likely to be prescribed cholinesterase inhibitors if their primary care physician saw ≥ 30 versus < 20 patients daily. Conclusions People with dementia were more likely to receive both potentially harmful and potentially beneficial medications, and slightly less likely to be vaccinated by high-volume primary care physicians.

Effectiveness of a tablet‐based intervention for people living with dementia in primary care—A cluster randomized controlled trial

“…In Germany, primary care physicians (PCP) play a central role in the healthcare delivery for dementia 8–10 . A recent study reported between eight and 15 primary care visits per year among people living with dementia 11 . In our study, we found that people living with dementia visited their PCP on average almost three times over a 3‐month observation period 12 .…”

“…[8][9][10] A recent study reported between eight and 15 primary care visits per year among people living with dementia. 11 In our study, we found that people living with dementia visited their PCP on average almost three times over a 3month observation period. 12 Despite empirical evidence highlighting the key role of PCP in dementia healthcare provision, past research has acknowledged challenges in primary care and dementia.…”

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A comparative study on psychiatric morbidity among elderly population residing in old-age homes and community

“…In this study, cognitive impairment was similar to the observations of the few studies which already exists, which found the dementia rates ranging from 10% to 58.6% in OAHs. [ 6 15 16 17 18 19 20 ] The OAH group had greater rates of inadequate social support, whereas the community group had greater rates of great social support (8.3%). One of the studies found poor social support in OAH residents.…”