Educating primary care physicians in the management of Alzheimer's disease: using practice guidelines to set quality benchmarks

2009 ◽  
Vol 21 (S1) ◽  
pp. S44-S52 ◽  
Author(s):  
Debra L. Cherry ◽  
Carol Hahn ◽  
Barbara G. Vickrey
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Practice Guidelines ◽  
Primary Care Physicians ◽  
Care Management ◽  
Primary Care Providers ◽  
Dementia Care ◽  
Care Providers

ABSTRACTThis paper presents a strategy for training primary care physicians in the identification, diagnosis and management of Alzheimer's disease and related disorders. The strategy uses evidence-based practice guidelines to establish quality benchmarks and then provides training and other interventions to improve the quality of care received by these patients. The three projects described in this paper assumed that training of primary care physicians alone would not be sufficient to achieve the quality benchmarks derived from guidelines. The projects used creative training strategies supplemented by provider “tool kits”, provider checklists, educational detailing, and endorsement from organizational leadership to reinforce what the primary care providers learned in educational sessions. Each project also implemented a system of dementia care management to “wrap around” traditional primary care to ensure that quality benchmarks would be achieved. Outcomes of two completed studies support the premise that it is possible to improve quality of dementia care through physician education that occurs in association with a coordinated system of dementia care management and in collaboration with community agencies to access guideline-recommended social services.

scholarly journals Redefining the Care Continuum to Create a Pipeline to Dementia Care for Minority Populations

2020 ◽  
Vol 11 ◽  
pp. 215013272092168
Author(s):  
Tina R. Sadarangani ◽  
Vanessa Salcedo ◽  
Joshua Chodosh ◽  
Simona Kwon ◽  
Chau Trinh-Shevrin ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Asian American ◽  
Minority Groups ◽  
Primary Care Providers ◽  
Dementia Care ◽  
Care Providers ◽  
Community Based ◽  
Community Based Organizations

Multiple studies show that racial and ethnic minorities with low socioeconomic status are diagnosed with Alzheimer’s disease and Alzheimer’s disease–related dementias (AD/ADRD) in more advanced disease stages, receive fewer formal services, and have worse health outcomes. For primary care providers confronting this challenge, community-based organizations can be key partners in supporting earlier identification of AD/ADRD and earlier entry into treatment, especially for minority groups. The New York University Center for the Study of Asian American Health, set out to culturally adapt and translate The Kickstart-Assess-Evaluate-Refer (KAER) framework created by the Gerontological Society of America to support earlier detection of dementia in Asian American communities and assist in this community-clinical coordinated care. We found that CBOs play a vital role in dementia care, and are often the first point of contact for concerns around cognitive impairment in ethnically diverse communities. A major strength of these centers is that they provide culturally appropriate group education that focuses on whole group quality of life, rather than singling out any individual. They also offer holistic family-centered care and staff have a deep understanding of cultural and social issues that affect care, including family dynamics. For primary care providers confronting the challenge of delivering evidence-based dementia care in the context of the busy primary care settings, community-based organizations can be key partners in supporting earlier identification of AD/ADRD and earlier entry into treatment, especially for minority groups.

scholarly journals The Role of the Primary Care Physician in Alzheimer’s Disease

2011 ◽  
Vol 6 (1) ◽  
pp. 21
Author(s):  
Hélène Villars ◽  
Bruno Vellas ◽  
◽  
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Early Diagnosis ◽  
Primary Care Physicians ◽  
Psychological Symptoms ◽  
Primary Care Providers ◽  
Care Physician ◽  
Care Providers ◽  
Her Family

The increased incidence of Alzheimer’s disease (AD) and related dementias in European and other northern countries is creating a real challenge for primary care providers. Primary care physicians (PCPs) must follow the general objectives of identifying dementia and allowing early diagnosis, disclosing diagnosis to both the patient and his or her family, preventing and treating, if possible, the complications of AD (falls, malnutrition and behavioural and psychological symptoms) and implementing a follow-up plan. It is essential for PCPs to develop interactions with specialist physicians and community professionals who intervene in the management of AD patients. The need for better education and training programmes for PCPs has been demonstrated in the literature in both the early diagnosis and management of AD. Clear guidelines specifically addressed to PCPs are needed.

scholarly journals Promoting Conversations About Cognitive Decline Between Older Adults and Primary Care Providers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 157-158
Author(s):  
Benjamin Olivari ◽  
Christopher Taylor ◽  
Nia Reed ◽  
Lisa McGuire
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Chronic Conditions ◽  
Memory Loss ◽  
Primary Care Providers ◽  
Subjective Cognitive Decline ◽  
Care Providers

Abstract Alzheimer’s disease and related dementias often begin with symptoms of mild memory loss, eventually leading to more severe cognitive impairment, functional impairment, and ultimately, death. Data from the Behavioral Risk Factor Surveillance System core questions related to chronic diseases and from the cognitive decline optional module on subjective cognitive decline (SCD) from the years 2015-2018 were aggregated across the participating 50 states, D.C., and Puerto Rico for this analysis. Among U.S. adults aged 65 years and older, only 39.8% (95%CI=37.6-42.1) of those experiencing SCD reported discussing their SCD symptoms with a healthcare provider. The prevalence of discussing SCD symptoms with a provider was higher among those with at least one chronic condition than among those with no chronic conditions. 30.7% (28.6-32.8) of those aged 65 years and older reported that their SCD led to functional limitations and 28.8% (26.5-31.2) needed assistance with day-to-day activities. For patients aged 65 years and older, Welcome to Medicare visits and Medicare Annual Wellness Visits are critically underutilized primary care access points. Primary care providers can manage chronic conditions, cognitive health, and initiate referrals for testing. Efforts to promote the use of toolkits and diagnostic codes that are available to primary care providers to initiate conversations about memory loss with patients may be utilized to improve detection, diagnosis, and planning for memory problems. Discussions may lead to earlier detection and diagnosis of cognitive impairment, such as Alzheimer’s disease, or other treatable conditions such as delirium or pressure in the brain and avoid costly hospitalizations.

Compliance, capacity, and quality in colonoscopy screening for CRC: A novel solution.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 357-357 ◽  
Author(s):  
S. C. Lloyd
Keyword(s):  
Primary Care ◽  
Training Program ◽  
Primary Care Physicians ◽  
African American Men ◽  
Primary Care Providers ◽  
Care Providers ◽  
Adenoma Detection ◽  
Before And After ◽  
Outstanding Quality

357 Background: CRC is predominately preventable with high quality colonoscopy screenings. Unfortunately, less than half of Americans are “up-to-date.” When referred by primary care providers, less than half complete the process. We proposed to include the primary care provider (PCP) in a novel training program to extend skills from sigmoidoscopy to full colonoscopy in a “mentored and monitored” model. We know that quality in colonoscopy can vary widely (ten fold within a single 12-man group). The protective benefits of colonoscopy reflect the thoroughness of the removal of polyps. Unfortunately, the ACS projections for 2010 predict an increase of 4,400 deaths from CRC over 2009, an 8% rise! Furthermore the death rate for African American men has RISEN 28% since 1960. We are loosing a battle for which we posses the tools to win. To achieve victory we must successfully address all three factors: compliance, capacity and quality. Methods: Thirty primary care physicians in two states (SC, FL) were recruited. We measured compliance rates within the practice before and after enrollment. We further evaluated quality of the colonoscopies as reflected in completion, yield and complications. Results: Compliance more than doubled (38% to 84%). As a compliance enhancement tool, the results were outstanding. The evaluation of quality then became of paramount importance. The gross completion rate was 98.3%, the adenoma detection rate (reflecting polyp yield) was 38%. In over 20,000 cases there were only 5 perforations, substantially below published rates. The quality was consistently at the level of experienced conscientious gastroenterologists. The details of the training program and the use of the “two-man” colonoscopy technique have been reviewed elsewhere (MEDICAL CARE, Aug 2010). Conclusions: If replicated nationally, this model has the potential for saving 25,000 lives annually. The participation of the patient's PCP is a powerful influence for improved compliance. The availability of an “expert” for mentoring and monitoring results in outstanding and consistent quality. The model has the potential to dramatically enhance compliance simultaneously increasing capacity while maintaining outstanding quality. No significant financial relationships to disclose.

Early Diagnosis of Alzheimer’s Disease in the Primary Care Setting

2020 ◽  
Author(s):  
◽  
Raymond Romano ◽  
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Early Diagnosis ◽  
Care Setting ◽  
Primary Care Setting ◽  
Early Recognition ◽  
Primary Care Providers ◽  
Care Providers ◽  
Term Care

The burden of Alzheimer’s disease (AD) affects not just the individual but also families, providers, and society. Early recognition and diagnosis of AD may reduce cost by reducing interaction with the health care system, earlier initiation of treatment, and prolonging time to long- term care. Primary care providers, the first contact for diagnosis of patients with AD, are not fulfilling the potential of early diagnosis for a variety of reasons. Biomarkers of AD emerge on average 15 to 20 years before clinical diagnosis, yet currently established biomarkers are not easily available in the primary care setting. A growing body of literature is focused on identifying additional non-invasive early signs of AD. The aims of this program of research were to understand factors contributing to the AD diagnosis variability in primary care settings and methods to improve early diagnosis by primary care providers. Four studies were undertaken to achieve these aims. The first study reported the results of an integrated review estimating the prevalence of missed diagnosis in primary care when compared to trained raters’ diagnoses. The findings call to attention the difficulty primary care providers face to detect and diagnose AD at all levels of the healthcare system. This led to the second study. Chronic pain is a common comorbid ailment seen in those with AD and often is a driving factor of patients seeking medical care. In order to understand the pain experience in those with worsening cognition, the second study was a secondary analysis of a cross-sectional age- and sex-matched two group cohort study and found that the experience of pain differs between males and females as a measure of cognition worsened suggesting a possible role of pain as a tool to distinguish those at risk for AD. This finding led to the third study, which was a narrative review conducted to describe how alterations in senses have been associated with the diagnosis of AD. The results suggested differences in smell, taste, vision, hearing, and proprioception were associated with different levels of the AD continuum but points out an obvious gap in the literature concerning other senses. This led to the fourth study examining evidence that the ε4 allele of Apolipoprotein E modifies the experience of pain in those individuals carrying the allele such that greater temperatures are required to elicit pain and the experience of that pain is more unpleasant. Additional studies should expand on the results of this pilot study.

scholarly journals Choosing Unwisely: Dissemination Needs of Primary Care Providers of Patients with Alzheimer’s Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 646-646
Author(s):  
Lee Lindquist ◽  
Aylin Madore ◽  
Stephanie Miller ◽  
Theresa Rowe ◽  
Sara Bradley
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Primary Care Providers ◽  
Choosing Wisely ◽  
Care Providers ◽  
Clinical Practices ◽  
Clinical Scenarios ◽  
National Cohort ◽  
End Stage

Abstract Choosing Wisely is a well-known campaign to disseminate evidence-based clinical practices to providers and patients to drive care decisions, with geriatrics recommendations released in 2013. In December 2019, we aimed to determine what the dissemination needs of primary care providers were towards these recommendations. We developed common clinical scenarios with follow-up survey questions, relative to the care of people with Alzheimer’s disease (AD) and utilizing Choosing Wisely geriatrics recommendations. The survey was distributed online to a national cohort of providers. Providers were also asked to rate their confidence level and rationale for clinical choices. Results were analyzed used mixed methodology, with constant comparative analysis utilized for qualitative responses. Nationally from 41/50 states, 211 providers responded, 72% female, with occupations of physician (36%, 77), advanced practice nurse (50%, 106) and physician assistant (13%, 28), with family practice (63%, 142) and internal medicine (20%, 43) the most prominent fields. Results revealed erroneous geriatric practices, including 1.)checking urinalysis for mental-status changes (55%, 116), 2.)treating asymptomatic bacteria with unnecessary antibiotics (59%, 124), 3.)placement of gastric tubes in end-stage dementia (11%, 23). Qualitative analysis of rationale for incorrect responses revealed knowledge misconceptions (e.g.feeding tube would help avoid aspiration). Confidence levels were high among providers as 75.9% rated themselves as above average, yet did not correlate to clinical errors. Choosing Wisely geriatrics recommendations are not being followed by some providers. Highly confident providers made errors similar to lower confident providers. New ways to disseminate geriatric recommendations are needed to improve the care of patients with AD.

scholarly journals Online Ratings of Primary Care Physicians: Comparison of Gender, Training, and Specialty

2021 ◽  
Vol 8 ◽  
pp. 237437352110077
Author(s):  
Daliah Wachs ◽  
Victoria Lorah ◽  
Allison Boynton ◽  
Amanda Hertzler ◽  
Brandon Nichols ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Waiting Times ◽  
Wait Time ◽  
Primary Care Providers ◽  
Wait Times ◽  
Care Providers ◽  
Female Physicians ◽  
Online Ratings ◽  
And Gender

The purpose of this study was to explore patient perceptions of primary care providers and their offices relative to their physician’s philosophy (medical degree [MD] vs doctorate in osteopathic medicine [DO]), specialty (internal medicine vs family medicine), US region, and gender (male vs female). Using the Healthgrades website, the average satisfaction rating for the physician, office parameters, and wait time were collected and analyzed for 1267 physicians. We found female doctors tended to have lower ratings in the Midwest, and staff friendliness of female physicians were rated lower in the northwest. In the northeast, male and female MDs were rated more highly than DOs. Wait times varied regionally, with northeast and northwest regions having the shortest wait times. Overall satisfaction was generally high for most physicians. Regional differences in perception of a physician based on gender or degree may have roots in local culture, including proximity to a DO school, comfort with female physicians, and expectations for waiting times.

Mild cognitive impairment in primary care: a clinical review

2018 ◽  
Vol 94 (1117) ◽  
pp. 647-652 ◽  
Author(s):  
Georges Assaf ◽  
Maria Tanielian
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Clinical Review ◽  
Primary Care Physicians ◽  
Early Recognition ◽  
Neuropsychiatric Symptoms ◽  
Evidenced Based

Dementia is projected to become a global health priority but often not diagnosed in its earlier preclinical stage which is mild cognitive impairment (MCI). MCI is generally referred as a transition state between normal cognition and Alzheimer’s disease. Primary care physicians play an important role in its early diagnosis and identification of patients most likely to progress to Alzheimer’s disease while offering evidenced-based interventions that may reverse or halt the progression to further cognitive impairment. The aim of this review is to introduce the concept of MCI in primary care through a case-based clinical review. We discuss the case of a patient with MCI and provide an evidence-based framework for assessment, early recognition and management of MCI while addressing associated risk factors, neuropsychiatric symptoms and prognosis.

scholarly journals Private ownership of primary care providers associated with patient perceived quality of care

Medicine ◽  
2017 ◽  
Vol 96 (1) ◽  
pp. e5755 ◽  
Author(s):  
Xiaolin Wei ◽  
Jia Yin ◽  
Samuel Y.S. Wong ◽  
Sian M. Griffiths ◽  
Guanyang Zou ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Primary Care Providers ◽  
Perceived Quality ◽  
Private Ownership ◽  
Care Providers ◽  
Perceived Quality Of Care
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