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 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.

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.

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 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.

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 Prescribing and testing by primary care providers to assess adherence to the Choosing Wisely Canada recommendations: a retrospective cohort study

CMAJ Open ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. E603-E610
Author(s):  
Alexander Singer ◽  
Leanne Kosowan ◽  
Alan Katz ◽  
Kheira Jolin-Dahel ◽  
Karen Appel ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Care Providers ◽  
Choosing Wisely ◽  
Care Providers

scholarly journals Genetic Referral Patterns and Responses to Clinical Scenarios: A Survey of Primary Care Providers and Clinical Geneticists

2021 ◽  
Vol 12 ◽  
pp. 215013272110467
Author(s):  
Tina K. Truong ◽  
Aileen Kenneson ◽  
Ami R. Rosen ◽  
Rani H. Singh
Keyword(s):  
Primary Care ◽  
Genetic Testing ◽  
Primary Care Providers ◽  
The United States ◽  
Genetic Services ◽  
Care Providers ◽  
Referral Patterns ◽  
Practice Characteristics ◽  
Clinical Scenarios ◽  
Genetics Services

Introduction: Primary care physicians (PCPs) are considered the gatekeepers of genetic services, but they often underutilize or inappropriately utilize such services, leading to lack of early treatment, incorrect diagnoses, and unnecessary procedures. This study aims to delineate PCP referral patterns, including the frequency of, motivators for, and barriers to genetic referrals and testing in the present landscape of genomics. Methods: A 34-item online survey was distributed to PCPs in the United States (US). PCP demographics, practice characteristics, and referral patterns, motivators, and barriers were analyzed. Six hypothetical clinical scenarios included in the survey also were presented to a cohort of clinical geneticists. We calculated PCPs’ rates of ordering genetic tests and of referral to genetics services in the past year. Rates and responses to clinical scenarios were compared based on respondents’ personal and practice characteristics. Results: A total of 95 PCPs and 25 clinical geneticists participated. Among the PCPs, 79% reported referring and 50% reported ordering genetic testing in the last year. PCPs with genetic counselors (GCs) in their clinic referred at significantly higher rates than those without ( P = .008). White PCPs referred at significantly higher rates compared to Black or African American PCPs ( P = .009). The most commonly reported motivators for referring patients to genetic services were preference for specialist coordination, lack of knowledge, and family’s desire for risk information. The most commonly reported barriers were patient refusal, provider concerns about costs to patients, and uncertainty of when a genetic referral is appropriate. In response to clinical scenarios, clinical geneticists were in agreement about the need for genetic testing or referral for 2 of the scenarios. For these 2 scenarios, only 48% and 71% of PCPs indicated that they would offer genetic testing or referral, respectively. Conclusions: Responses to clinical scenarios suggest that it is not clear to PCPs when referrals or testing are needed. Collaboration with GCs is one approach to reducing barriers to and improving PCPs’ utilization of genetic services. Clear guidelines from clinical geneticists may help facilitate appropriate use of genetics services by PCPs. Additional research is needed to further describe barriers that PCPs face in genetic testing/referrals.

scholarly journals Perceived Barriers to Implementing Individual Choosing Wisely® Recommendations in Two National Surveys of Primary Care Providers

2016 ◽  
Vol 32 (2) ◽  
pp. 210-217 ◽  
Author(s):  
Brian J. Zikmund-Fisher ◽  
Jeffrey T. Kullgren ◽  
Angela Fagerlin ◽  
Mandi L. Klamerus ◽  
Steven J. Bernstein ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Perceived Barriers ◽  
Choosing Wisely ◽  
Care Providers ◽  
National Surveys

scholarly journals P.039 Generating choosing wisely Canada recommendations for neurology

2019 ◽  
Vol 46 (s1) ◽  
pp. S24
Author(s):  
C Beyak ◽  
F Costello ◽  
P Couillard
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Online Survey ◽  
Care Delivery ◽  
Primary Care Providers ◽  
Choosing Wisely ◽  
Board Members ◽  
Care Providers ◽  
Short List ◽  
Survey Results

Background: Many guidelines in neurology encompass the principles of Choosing Wisely Canada (CWC): resource stewardship, patient safety, and high value care. There are currently 49 medical societies with CWC recommendations excluding the Canadian Neurologic Society (CNS). Methods: A descriptive process for list generation is outlined. A review of the American Choosing Wisely recommendations was undertaken to generate an adapted list of ten recommendations. CNS board members vetted this list and an online survey was sent to each CNS member. Results: A short list of recommendations endorsed by the CNS membership at large will be presented according to the survey results. CWC promotion of the list will take place to reach specialists, primary care providers, and trainees to ensure high value neurological care delivery is the standard across Canada. Conclusions: The process to delineate CWC recommendations for neurology is outlined. Participating in the CWC movement is an important leadership initiative for the CNS. It demonstrates the commitment of Canadian neurologists to the principles of high value patient care in neurology.

scholarly journals How do physicians and nurses in family practice describe their care for patients with progressive life-limiting illness? A qualitative study of a ‘palliative approach’

2019 ◽  
Vol 20 ◽  
Author(s):  
Alex Rewegan ◽  
Sharef Danho ◽  
Joy White ◽  
Samantha Winemaker ◽  
Nicolle Hansen ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Functional Decline ◽  
Primary Care Providers ◽  
Care Providers ◽  
Clinical Practices ◽  
Structured Interviews ◽  
Team Members ◽  
Palliative Approach ◽  
Primary Care Clinicians

Abstract Aim: To explore how a palliative approach to care is operationalized in primary care, through the description of clinical practices used by primary care clinicians to identify and care for patients with progressive life-limiting illness (PLLI). Background: Increasing numbers of people are living with PLLI but are often not recognized as needing a palliative approach to care. To meet growing needs, generalists such as family physicians will need to adopt a palliative approach to care in their own setting. Practical descriptions of a palliative approach in non-specialist settings have been lacking. Methods: We conducted a qualitative descriptive study design using in-depth semi-structured interviews with 11 key informant participants (6 physicians, 3 nurse practitioners, 1 registered nurse, and 1 registered practical nurse) known to be providing comprehensive care to patients with PLLI in family practices in Ontario, Canada. We asked about their approach to identifying patients with PLLI and the strategies used in their care. We employed content analysis to develop themes. Findings: Participants identified patients by functional decline, change in needs, increased acuity, and the specifics of a condition/diagnosis. Care strategies included concretizing commitment to care, eliciting goals of care, shifting care to the home, broadening team members including leveraging the support of family and community resources, and shifting to a ‘proactive’ approach involving increased follow-up, flexibility, and intensity. Conclusion: Primary care providers articulated strategies for identifying and providing care to patients with PLLI that illuminate an upstream approach tailored to their setting.

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