Survey of physician practices for community-dwelling agitated dementia patients

Abstract

In order to gain a better understanding of physician clinical reasoning and clinical practices for community‐dwelling agitated dementia patients, we conducted a small survey of geriatric psychiatrists, primary care physicians and neurologists. The survey asked physician respondents to give a likelihood estimate of how often they would carry out one of 13 different pharmacologic and psychosocial interventions. Intervention by specialty group analyses found that geriatric psychiatrists were more likely to recommend neuroleptic medications and dementia support group activities, but less likely to recommend referral to behavioral specialists than the other physician groups. Neurologists were more likely to recommend dementia support groups than primary care physicians, but they were also more likely to recommend institutional placement than the other physician groups. Primary care physicians were more likely to recommend hydroxyzine than either neurologists or geriatric psychiatrists. Multivariate ordinal logistic regression analysis found that older physicians and primary care physicians expressed a lower likelihood of recommending dementia day care programs and a higher likelihood of recommending hydroxyzine. Women physicians, however, expressed a high likelihood of recommending dementia day care programs. The results of the survey suggest that personal and specialty characteristics of physicians influence the types of treatment recommendations made for agitated dementia patients. The results may help community‐based dementia care programs to develop strategies that broaden physician involvement in multidisciplinary team management for these patients.

General practitioners' knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia: A mixed‐methods systematic review

“…Three of the descriptive cross‐sectional studies were rated as low quality (achieving only 3 out of 7 quality markers). These studies all reported on the same cohort . The overall quality of the other 4 descriptive cross‐sectional studies ranged from moderate to high (File S6 and Table ).…”

“…The overall quality of the other 4 descriptive cross‐sectional studies ranged from moderate to high (File S6 and Table ). Common areas of weakness were the lack of involvement of the target population in the instrument development and the lack of clarity on whether the sample used in the study was likely to be representative of the study population . None of the descriptive cross‐sectional studies provided a sample size justification, statistical power description, or variance and effect estimates.…”

“…Nearly all the included studies examined issues pertaining to GPs' knowledge and self‐efficacy . In some studies, BPSD was considered by GPs to be “ very difficult to deal with ” and “distressing.” General practitioners tended to be “critical of their perceived skills in the diagnosis and management of BPSD.” Specifically, in some studies, GPs were critical of their knowledge of prescribing psychotropic medications: “ When do you add in psychotropic medication, what type of medication, what dosages, for how long?…”

Physicians’ practice and familiarity with treatment for agitation associated with dementia in Israeli nursing homes

“…In a USA survey (Colenda et al, 1996b) comparing physicians' treatment recommendations for agitation in dementia patients, medication use was endorsed over twice as often as nonpharmacological interventions. Recommendations for treatment were found to be affected by physicians' personal characteristics, including age, gender, and specialty (Colenda et al, 1996a), as well as by factors such as being pressured and lacking other options (Cornegé-Blokland et al, 2012). Recommendations for treatment were found to be affected by physicians' personal characteristics, including age, gender, and specialty (Colenda et al, 1996a), as well as by factors such as being pressured and lacking other options (Cornegé-Blokland et al, 2012).…”

“…We hypothesize that (1) most physicians will report treating agitation with psychotropic medication, that (2) physicians' treatment modalities will differ by personal characteristics (Colenda et al, 1996a), and that (3) physicians' levels of familiarity with non-pharmacological interventions will differ by personal characteristics. It aims to clarify physicians' actual practice in treating agitation, and to elucidate the relationship between practice, physicians' background factors, and familiarity with interventions.…”