scholarly journals Dementia diagnostics in primary care : with a focus on cognitive testing

2019 ◽  
Author(s):  
Anna Segernäs Kvitting
Keyword(s):  
Primary Care ◽  
Cognitive Testing ◽  
Dementia Diagnostics

scholarly journals Factors influencing general practitioners’ perception of and attitude towards dementia diagnostics and care—results of a survey among primary care physicians in Germany

2021 ◽  
Author(s):  
Julian Wangler ◽  
Michael Jansky
Keyword(s):  
Primary Care ◽  
Influencing Factors ◽  
General Practitioners ◽  
Primary Care Physicians ◽  
Descriptive Analysis ◽  
Linear Regression Analysis ◽  
Interdisciplinary Cooperation ◽  
Practice Staff ◽  
People With Dementia ◽  
Dementia Diagnostics

SummaryStudies have shown that primary care is not always effective when it comes to caring for people with dementia. In addition, general practitioners do not always use diagnostic instruments consistently. The aim of the study was to identify relevant factors that influence general practitioners’ attitudes and willingness with respect to consistent diagnosis and care. For this purpose, resources, viewpoints, and behavioral patterns of general practitioners with regard to dementia diagnostics as well as common challenges in everyday practice were recorded. In the course of a survey, a total of 2266 general practitioners in Hesse and Baden-Württemberg were interviewed between January and March 2020. In addition to the descriptive analysis, a t-test was used to determine significant differences between two groups. A univariate linear regression analysis was carried out to identify possible influencing factors. 81% of the respondents do provide dementia diagnostics; 51% are involved in the treatment. Most of them see the diagnostic work-up (77%), communication and compliance problems (73%), as well as the therapeutic support (71%) as common challenges. In addition, there are interface problems regarding the interdisciplinary cooperation. Some of the respondents express doubts about the value of early detection (41%). The general practitioners’ attitude with respect to dementia diagnostics and care is determined by influencing factors that relate to geriatric competencies, expectations of self-efficacy, the integration of practice staff, as well as the knowledge of and cooperation with counseling and care services. It seems advisable to strengthen the geriatric competence of general practitioners. Moreover, it appears essential to educate general practitioners more about support structures in the field of dementia care and to integrate them accordingly. In addition, practice staff should be more systematically involved in the identification and care of dementia patients.

scholarly journals Cognitive testing in older primary care patients: A cluster‐randomized trial

2015 ◽  
Vol 1 (3) ◽  
pp. 349-357 ◽  
Author(s):  
Nicole R. Fowler ◽  
Lisa Morrow ◽  
Laurel Chiappetta ◽  
Beth Snitz ◽  
Kimberly Huber ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Cognitive Testing ◽  
Primary Care Patients ◽  
Cluster Randomized

scholarly journals Dementia assessment and management in primary care settings: a survey of current provider practices in the United States

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Alissa Bernstein ◽  
Kirsten M. Rogers ◽  
Katherine L. Possin ◽  
Natasha Z.R. Steele ◽  
Christine S. Ritchie ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Clinical Practice ◽  
Diagnostic Criteria ◽  
Management Practices ◽  
Primary Care Providers ◽  
The United States ◽  
Cognitive Testing ◽  
Care Providers ◽  
High Confidence

Abstract Background Primary care providers (PCPs) are typically the first to screen and evaluate patients for neurocognitive disorders (NCDs), including mild cognitive impairment and dementia. However, data on PCP attitudes and evaluation and management practices are sparse. Our objective was to quantify perspectives and behaviors of PCPs and neurologists with respect to NCD evaluation and management. Methods A cross-sectional survey with 150 PCPs and 50 neurologists in the United States who evaluated more than 10 patients over age 55 per month. The 51-item survey assessed clinical practice characteristics, and confidence, perceived barriers, and typical practices when diagnosing and managing patients with NCDs. Results PCPs and neurologists reported similar confidence and approaches to general medical care and laboratory testing. Though over half of PCPs performed cognitive screening or referred patients for cognitive testing in over 50% of their patients, only 20% reported high confidence in interpreting results of cognitive tests. PCPs were more likely to order CT scans than MRIs, and only 14% of PCPs reported high confidence interpreting brain imaging findings, compared to 70% of specialists. Only 21% of PCPs were highly confident that they correctly recognized when a patient had an NCD, and only 13% were highly confident in making a specific NCD diagnosis (compared to 72 and 44% for neurologists, both p < 0.001). A quarter of all providers identified lack of familiarity with diagnostic criteria for NCD syndromes as a barrier to clinical practice. Conclusions This study demonstrates how PCPs approach diagnosis and management of patients with NCDs, and identified areas for improvement in regards to cognitive testing and neuroimaging. This study also identified all providers’ lack of familiarity with published diagnostic criteria for NCD syndromes. These findings may inform the development of new policies and interventions to help providers improve the efficacy of their decision processes and deliver better quality care to patients with NCDs.

O2-07-06: The effects of computerized cognitive testing of older patients on primary care physicians' care strategies

2015 ◽  
Vol 11 (7S_Part_4) ◽  
pp. P190-P191
Author(s):  
Mary C. Tierney ◽  
Jocelyn Charles ◽  
R. Liisa Jaakkimainen ◽  
Ross Upshur ◽  
Gary Naglie ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Older Patients ◽  
Cognitive Testing

scholarly journals Dementia diagnostics in general practitioner care

2019 ◽  
Vol 170 (9-10) ◽  
pp. 230-237
Author(s):  
Julian Wangler ◽  
Michael Jansky
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Differential Diagnostics ◽  
Structured Interviews ◽  
Treatment Pathways ◽  
Personal Initiative ◽  
Physician Patient Communication ◽  
Diagnosis Of Dementia ◽  
Dementia Diagnostics ◽  
Physician Patient

SummaryGeneral practitioner (GP) treatment of dementia is often criticized as being ineffective and not implemented consistently enough. The causes and specific standpoints of GPs have not previously been thoroughly investigated. This paper focuses on the reasons and the criticisms levelled at GPs with regard to diagnosing dementia, and identifies approaches to enable optimization. The analysis is based on 41 semi-structured interviews with GPs in Hesse, Germany, in 2018. During the course of a content analysis, the interviewees’ attitudes and behavioral patterns towards dementia diagnostics were to be analyzed. The results of the study show various challenges and problems of primary care in this field. The majority of the sample showed skepticism and reluctance with regard to the diagnosis of dementia. Six key problem areas were extracted from the interviews, which can be seen as root causes for the distance kept by GPs: 1) early delegation of patients due to role understanding, 2) attitude of pessimism towards dementia, 3) differential diagnosis perceived as an obstacle, 4) insufficient remuneration, 5) fear of patient stigmatization, and 6) lack of application. Some GPs demonstrated personal initiative with the aim of optimizing dementia diagnostics. Three approaches can be derived which could be used to improve the GP-based care of dementia: 1) self-efficacy, 2) differential diagnostics and treatment pathways, and 3) physician–patient communication.

scholarly journals Take Action or Worry? Older Adults’ Anticipated Responses to Concerning Cognitive Assessment Results

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 366-366
Author(s):  
Claudia Jacova ◽  
Sara Wong ◽  
Samantha Smith
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Cognitive Assessment ◽  
Theoretical Models ◽  
Cognitive Disorder ◽  
Community Dwelling ◽  
Cognitive Testing ◽  
Cognitive Assessments ◽  
Cognitive Problems ◽  
Assessment Results

Abstract Under a third of older adults (28%) report having ever received an assessment for cognitive problems in US primary care settings. Patient resistance is cited as a major reason cognitive assessments are not performed. Theoretical models emphasize the role of anticipated benefits and harms in shaping health behaviors. Accordingly, here we investigated older adults’ anticipated actions and worries regarding their cognitive assessment results. A total of 393 community-dwelling respondents between ages 50 and 91, 65% female, 89% college/university-educated, with no diagnosed cognitive disorder, completed Attitudes Around Cognitive Testing (AACT) at primary care sites (n=98) and through an online platform (www.mturk.com) (n=298). AACT examines older adults’ preferences and concerns about cognitive assessment. It includes questions about actions participants would take and worries they would have if assessment results indicated cognitive problems. Willingness to take part in testing (yes or unsure/no) was also assessed. We found that seeking a formal diagnosis (84%), talking to family about healthcare (77%), and planning one’s own future (70%) were highly endorsed actions, and becoming depressed (48%), becoming anxious (47%), and losing driving privileges (41%) highly endorsed worries. Logistic regression showed that total worries and worry-action difference scores predicted reduced willingness (OR=0.84, CI=0.75-0.93 and OR=0.82, CI=0.74-0.82, respectively), whereas total actions did not. Our results suggest that older adults view concerning cognitive assessment outcomes as an opportunity for taking action as well as a reason for worrying. Both worries and actions appear to play a role in deciding whether to take part in a cognitive assessment.

The Effects of Computerized Cognitive Testing of Older Patients on Primary Care Physicians’ Approaches to Care

2017 ◽  
Vol 31 (1) ◽  
pp. 62-68 ◽  
Author(s):  
Mary C. Tierney ◽  
Jocelyn Charles ◽  
Gary Naglie ◽  
Liisa Jaakkimainen ◽  
Rahim Moineddin
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Older Patients ◽  
Cognitive Testing

scholarly journals Dementia Diagnostics in Primary Care: A Representative 8-Year Follow-Up Study in Lower Saxony, Germany

2007 ◽  
Vol 25 (2) ◽  
pp. 127-134 ◽  
Author(s):  
Lienhard Maeck ◽  
Sebastian Haak ◽  
Anita Knoblauch ◽  
Gabriela Stoppe
Keyword(s):  
Primary Care ◽  
Lower Saxony ◽  
Follow Up Study ◽  
Dementia Diagnostics

Computerized Cognitive Testing in Primary Care

2018 ◽  
Vol 32 (2) ◽  
pp. 114-119 ◽  
Author(s):  
Geneva Millett ◽  
Gary Naglie ◽  
Ross Upshur ◽  
Liisa Jaakkimainen ◽  
Jocelyn Charles ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Testing

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

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