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Lech S, Gellert P, Spang RP, Voigt-Antons JN, Huscher D, O'Sullivan JL, Schuster J. Effectiveness of a tablet-based intervention for people living with dementia in primary care-A cluster randomized controlled trial. Int J Geriatr Psychiatry 2023; 38:e6035. [PMID: 38038608 DOI: 10.1002/gps.6035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/18/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Primary care physicians (PCP) play a key role in the care of people living with dementia. However, the implementation and practicability of the German S3 Dementia Guideline in primary care remain unclear. The main objective of the present study was to evaluate an intervention for improving guideline-based dementia care in primary care. DESIGN A two-arm, 9-month follow-up cluster-randomized controlled trial with two parallel groups. SETTING 28 primary care practices in Berlin and the surrounding area in Germany. PARTICIPANTS A total of N = 28 PCP, N = 91 people living with dementia, and N = 88 informal caregivers participated in the trial. INTERVENTION A tablet-based intervention to improve adherence to the German S3 Dementia Guideline in primary care was compared to a control group (care as usual plus a handbook on dementia). MeasurementsAdherence to dementia guideline (primary outcome) was measured on PCP' (23 items) and informal caregivers' level (19 items) with a self-developed checklist. Secondary outcomes (quality of life, neuropsychiatric symptoms, activities of daily living, general health status, depression, and caregiver burden) were measured with standardized assessments. Also, post-hoc per-protocol analyses were conducted. RESULTS No differences in guideline adherence between the intervention and the control group were observed. Further, no significant impact of the intervention on secondary outcomes was detected. CONCLUSION The DemTab Study did not improve self-reported guideline adherence in PCP. However, important implementation barriers such as lack of interoperability and low applicability of existing German S3 Dementia Guideline in the primary care setting were identified and are being discussed. TRIAL REGISTRATION The DemTab trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413). Registered 01 April 2019, https://doi.org/10.1186/ISRCTN15854413.
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Affiliation(s)
- Sonia Lech
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Paul Gellert
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Robert P Spang
- Technische Universität Berlin, Quality and Usability Lab, Berlin, Germany
| | - Jan-Niklas Voigt-Antons
- Immersive Reality Lab, University of Applied Sciences Hamm-Lippstadt, Lippstadt, Germany
- Deutsches Forschungszentrum für Künstliche Intelligenz GmbH (DFKI), Speech and Language Technology, Berlin, Germany
| | - Dörte Huscher
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Berlin, Germany
| | - Julie L O'Sullivan
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Johanna Schuster
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany
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Hochgraeber I, Dreyer J, Köhler K, Pinkert C, Holle B. [Do guidelines for care practice address the stability of home-based care arrangements for people with dementia?-A document analysis]. Z Gerontol Geriatr 2022; 56:209-214. [PMID: 35103813 DOI: 10.1007/s00391-022-02024-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The care of people with dementia (PwD) living at home is mainly provided by family carers who intend to maintain care at home for as long as possible. In the DZNE-SoCA project, a middle range theory of stability of home-based care arrangements for people living with dementia (SoCA-Dem theory) has been developed. The theory helps to understand the complex phenomenon of stability, provides a theoretical framework that can guide future research and can be used for the (further) development of home care structures. AIM The aim of this substudy of the SoCA project was to examine whether the SoCA-Dem theory can guide German health and social care practice in dealing with family carers of PwD. MATERIAL AND METHODS The two guidelines for healthcare professionals, the concept of the Centre for Quality in Care (ZQP) "Quality framework for counselling in care" and the DEGAM guidelines for general practitioners "Family carers of adults", were evaluated using a content analysis with respect to the SoCA-Dem theory. RESULTS Most concepts that constitute stability are addressed in both guidelines. The SoCA-Dem theory illustrates the importance of the interaction between the different concepts for the stability of home-based care arrangements. In the guidelines, the dynamic interplay remains unclear. CONCLUSION The SoCA-Dem theory seems to be compatible with the German health care context and can support a future shift from a stress-oriented view of giving care to a more comprehensive one.
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Affiliation(s)
- Iris Hochgraeber
- Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Witten, Deutschland. .,Department Pflegewissenschaft, Universität Witten/Herdecke, Witten, Deutschland.
| | - Jan Dreyer
- Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Witten, Deutschland.,Department Pflegewissenschaft, Universität Witten/Herdecke, Witten, Deutschland
| | - Kerstin Köhler
- Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Witten, Deutschland.,Department Pflegewissenschaft, Universität Witten/Herdecke, Witten, Deutschland
| | - Christiane Pinkert
- Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Witten, Deutschland.,Department Pflegewissenschaft, Universität Witten/Herdecke, Witten, Deutschland
| | - Bernhard Holle
- Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Witten, Deutschland.,Department Pflegewissenschaft, Universität Witten/Herdecke, Witten, Deutschland
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3
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Lech S, O'Sullivan JL, Drewelies J, Herrmann W, Spang RP, Voigt-Antons JN, Nordheim J, Gellert P. Dementia care and the role of guideline adherence in primary care: cross-sectional findings from the DemTab study. BMC Geriatr 2021; 21:717. [PMID: 34922486 PMCID: PMC8683809 DOI: 10.1186/s12877-021-02650-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022] Open
Abstract
Background General practitioners (GPs) play a key role in the care of people with dementia (PwD). However, the role of the German Dementia Guideline in primary care remains unclear. The main objective of the present study was to examine the role of guideline-based dementia care in general practices. Methods A cross-sectional analysis of data obtained from the DemTab study was conducted. Descriptive analyses of sociodemographic and clinical characteristics for GPs (N = 28) and PwD (N = 91) were conducted. Adherence to the German Dementia Guideline of GPs was measured at the level of PwD. Linear Mixed Models were used to analyze the associations between adherence to the German Dementia Guideline and GP factors at individual (age, years of experience as a GP, frequency of utilization of guideline, perceived usefulness of guideline) and structural (type of practice, total number of patients seen by a participating GP, and total number of PwD seen by a participating GP) levels as well as between adherence to the German Dementia Guideline and PwD’s quality of life. Results Self-reported overall adherence of GPs was on average 71% (SD = 19.4, range: 25–100). Adherence to specific recommendations varied widely (from 19.2 to 95.3%) and the majority of GPs (79.1%) reported the guideline as only partially or somewhat helpful. Further, we found lower adherence to be significantly associated with higher numbers of patients (γ10 = − 5.58, CI = − 10.97, − 0.19, p = .04). No association between adherence to the guideline and PwD’s quality of life was found (γ10 = −.86, CI = − 4.18, 2.47, p = .61). Conclusion The present study examined the role of adherence to the German Dementia Guideline recommendations in primary care. Overall, GPs reported high levels of adherence. However, major differences across guideline recommendations were found. Findings highlight the importance of guidelines for the provision of care. Dementia guidelines for GPs need to be better tailored and addressed. Further, structural changes such as more time for PwD may contribute to a sustainable change of dementia care in primary care. Trial registration The DemTab trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413). Registered 01 April 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02650-8.
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Affiliation(s)
- Sonia Lech
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany. .,Brandenburg Medical School Theodor Fontane, Department of Psychiatry, Psychotherapy and Psychosomatics, Neuruppin, Germany.
| | - Julie L O'Sullivan
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Johanna Drewelies
- Department of Psychology, Humboldt Universität zu Berlin, Berlin, Germany
| | - Wolfram Herrmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of General Practice, Berlin, Germany
| | - Robert P Spang
- Technische Universität Berlin, Quality and Usability Lab, Berlin, Germany
| | - Jan-Niklas Voigt-Antons
- Technische Universität Berlin, Quality and Usability Lab, Berlin, Germany.,Deutsches Forschungszentrum für Künstliche Intelligenz GmbH (DFKI), Speech and Language Technology, Berlin, Germany
| | - Johanna Nordheim
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Paul Gellert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
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Eich-Krohm A, Robra BP, Marx Y, Herrmann M. Finding common (research) ground between general practitioners and neuroscientists: the vital role of knowledge circulation in closing the evidence-to-practice gap. BMC FAMILY PRACTICE 2021; 22:211. [PMID: 34666702 PMCID: PMC8527800 DOI: 10.1186/s12875-021-01560-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022]
Abstract
Background It may take 15 years or longer before research evidence is integrated into clinical practice. This evidence-to-practice gap has deleterious effects on patients as well as research and clinical processes. Bringing clinical knowledge into the research process, however, has the potential to close the evidence-to-practice gap. The NEUROTRANS-Project attempts to bring research and practice together by focusing on two groups that usually operate separately in their communities: general practitioners and neuroscientists. Although both groups focus on dementia as an area of work, they do so in different contexts and without opportunities to share their expertise. Finding new treatment pathways for patients with dementia will require an equal knowledge exchange among researchers and clinicians along with the integration of that knowledge into research processes, so that both groups will benefit from the expertise of the other. Methods The NEUROTRANS-Project uses a qualitative, multi-stage research design to explore how neuroscientists and general practitioners (GPs) approach dementia. Using a grounded theory methodology, it analyzes semi-structured interviews, case vignettes, focus groups with GPs in Saxony-Anhalt, Germany, and informal conversations with, and observations of, neuroscientists from the German Center for Neurodegenerative Diseases in Magdeburg. Results The NEUROTRANS-Project identified a clear division of labor between two highly specialized professional groups. Neuroscientists focus abstractly on nosology whereas general practitioners tend to patient care following a hermeneutic approach integrating the patients’ perspective of illness. These different approaches to dementia create a barrier to constructive dialogue and the capacity of these groups to do research together with a common aim. Additionally, the broader system of research funding and health care within which the two groups operate reinforces their divide thereby limiting joint research capacity. Conclusions Overcoming barriers to research collaboration between general practitioners and neuroscientists requires a shift in perspective in which both groups actively engage with the other’s viewpoints to facilitate knowledge circulation (KC). Bringing ‘art into science and science into art’, i.e. amalgamating the hermeneutic approach with the perspective of nosology, is the first step in developing joint research agendas that have the potential to close the evidence-to-practice gap. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01560-3.
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Affiliation(s)
- Astrid Eich-Krohm
- Faculty of Medicine, Otto-von-Guericke-University Magdeburg, Institute of Social Medicine and Health Systems Research, Leipziger Straße 44, 39120, Magdeburg, Germany.
| | - Bernt-Peter Robra
- Faculty of Medicine, Otto-von-Guericke-University Magdeburg, Institute of Social Medicine and Health Systems Research, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Yvonne Marx
- Faculty of Medicine, Otto-von-Guericke-University Magdeburg, Institute of General Practice, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Markus Herrmann
- Faculty of Medicine, Otto-von-Guericke-University Magdeburg, Institute of General Practice, Leipziger Straße 44, 39120, Magdeburg, Germany
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Müller B, Kropp P, Cardona MI, Michalowsky B, van den Berg N, Teipel S, Hoffmann W, Thyrian JR. Types of leisure time physical activities (LTPA) of community-dwelling persons who have been screened positive for dementia. BMC Geriatr 2021; 21:270. [PMID: 33892624 PMCID: PMC8063325 DOI: 10.1186/s12877-021-02201-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background To (a) describe the pattern of leisure time physical activities (LTPA) in community-dwelling persons who have been screened positive for dementia and (b) determine the health-related and sociodemographic factors associated with LTPA. Methods Data of the general practitioner-based, randomized, controlled intervention trial, DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) were used. Patients aged 70 years or older, who lived at home and had a DemTect< 9 were informed about the study by their General practitioners and invited to participate. Data from 436 participants with complete baseline data were used. Standardized, computer-assisted assessments were made during face-to-face interviews at the participants’ homes. Results Two hundred thirty-eight patients (54.6%) carried out LTPA (men 58.4%, women 51.8%). Physically active patients mentioned one to two different activities; diversity of LTPA was higher for men than for women. The most-frequently mentioned types of activity were gardening (35.3%), cycling (24.1%) and mobility training (12.4%); there was only a statistically significant difference between men and women in cycling, χ2(1) = 21.47, p < .001. The odds of LTPA increased with increasing quality of life (OR = 2.41), lower impairments in activities of daily living (OR = 0.85), and living in a rural environment (OR = 2.02). Conclusions Our findings suggest that people who have been screened positive for dementia living in a rural area are more likely to be active than people living in an urban area. Following studies should investigate whether this difference has an effect on the progression of dementia. Trial registration ClinicalTrial.gov Identifier NCT01401582. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02201-1.
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Affiliation(s)
- Britta Müller
- Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Gehlsheimer Str. 20 Rostock, 18147, Rostock, Germany.
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Gehlsheimer Str. 20 Rostock, 18147, Rostock, Germany
| | | | | | - Nanja van den Berg
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Psychosomatic and Psychotherapeutic Medicine, University Medicine Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Wang M, Xu X, Huang Y, Shao S, Chen X, Li J, Du J. Knowledge, attitudes and skills of dementia care in general practice: a cross-sectional study in primary health settings in Beijing, China. BMC FAMILY PRACTICE 2020; 21:89. [PMID: 32416731 PMCID: PMC7231407 DOI: 10.1186/s12875-020-01164-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/10/2020] [Indexed: 12/25/2022]
Abstract
Background General practitioners (GPs) play a significant role in dementia care. However, the knowledge and attitudes of them towards dementia care are poorly characterized. The present study aimed to investigate GPs’ knowledge, attitudes and skills of dementia care in primary health settings in Beijing. Methods A cross-sectional survey was conducted in 27 community health service centers (CHSCs) in Beijing. The GPs’ knowledge, attitudes and skills were assessed utilizing the Alzheimer’s Disease Knowledge Scale (ADKS), Dementia Care Attitude Scale (DCAS) and self-designed questionnaire, respectively. Results A total of 341 participants returned the questionnaire. The overall mean score of GPs’ dementia knowledge measured by the ADKS was 21.42 (SD = 2.73) out of 30 (71.4%), GPs’ attitudes to dementia care was 36.25 (SD = 5.12) out of 50 (72.5%), and GPs’ self-confidence on dementia care skills was 53.93 (SD = 9.57) out of 75 (71.9%). GPs’ overall knowledge towards dementia care was limited and the attitudes were generally positive. They had low level recognition of their roles towards dementia care. The majority of GPs believed that dementia care was within a specialist’s domain not that of general practice. Conclusion GPs demonstrate low levels of dementia knowledge and skills, but express generally positive attitudes towards dementia in this study. It is much needed to translate detailed dementia care handbook, and adequate dementia knowledge training for GPs into practice to improve care outcomes for people with dementia in China. In addition, dementia management should be covered in the national basic package of public health services in primary care.
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Affiliation(s)
- Meirong Wang
- School of General Practice and Continuing Education, Capital Medical University, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Xiaojingyuan Xu
- School of General Practice and Continuing Education, Capital Medical University, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Yafang Huang
- School of General Practice and Continuing Education, Capital Medical University, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Shuang Shao
- School of General Practice and Continuing Education, Capital Medical University, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Xiaolei Chen
- School of General Practice and Continuing Education, Capital Medical University, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Jing Li
- Dongfeng Community Health Service Center, Chaoyang district, Nan Shi Li Ju, Beijing, 100016, China.
| | - Juan Du
- School of General Practice and Continuing Education, Capital Medical University, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China.
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Parmar J, Anderson S, Abbasi M, Ahmadinejad S, Brémault-Phillips S, Chan K, Charles L, Dobbs BM, Khera AS, Stickney-Lee J, Tian PGJ. Support for family caregivers: A scoping review of family physician's perspectives on their role in supporting family caregivers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:716-733. [PMID: 31858674 DOI: 10.1111/hsc.12928] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/26/2019] [Accepted: 11/21/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Jasneet Parmar
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Covenant Health-Network of Excellence in Seniors' Health and Wellness, Edmonton, AB, Canada
- Grey Nuns Community Hospital, Marguerite Health Services Centre, Edmonton, AB, Canada
| | - Sharon Anderson
- Covenant Health-Network of Excellence in Seniors' Health and Wellness, Edmonton, AB, Canada
- Grey Nuns Community Hospital, Marguerite Health Services Centre, Edmonton, AB, Canada
| | - Marjan Abbasi
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Saeed Ahmadinejad
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, AB, Canada
| | - Karenn Chan
- Department of Family Medicine, Division of Care of the Elderly, University of Alberta, Edmonton, AB, Canada
| | - Lesley Charles
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Care of the Elderly, Glenrose Rehabilitation Hospital-East, Edmonton, AB, Canada
| | - Bonnie M Dobbs
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Family Medicine, Division of Care of the Elderly, University of Alberta, Edmonton, AB, Canada
- Medically At-Risk Driver Centre, University of Alberta, Edmonton, AB, Canada
| | - Amandeep Sheny Khera
- Department of Family Medicine, Division of Care of the Elderly, University of Alberta, Edmonton, AB, Canada
| | - Jennifer Stickney-Lee
- Supportive Living for AHS in the Edmonton Zone, Site Chief for Geriatrics at the Sturgeon Community Hospital, Edmonton, AB, Canada
| | - Peter George J Tian
- Department of Family Medicine, Division of Care of the Elderly, University of Alberta, Edmonton, AB, Canada
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Mansfield E, Noble N, Sanson-Fisher R, Mazza D, Bryant J. Primary Care Physicians' Perceived Barriers to Optimal Dementia Care: A Systematic Review. THE GERONTOLOGIST 2020; 59:e697-e708. [PMID: 29939234 DOI: 10.1093/geront/gny067] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Primary care physicians (PCPs) have a key role in providing care for people with dementia and their carers, however, a range of barriers prevent them from delivering optimal care. We reviewed studies on PCPs' perceptions of barriers to providing optimal dementia care, including their methodological quality, whether they focused on barriers related to diagnosis and/or management, and the patient-, provider-, and system-level barriers identified. RESEARCH DESIGN AND METHODS Studies were included if they were quantitative studies published since 2006 which reported on PCPs' perceptions of the barriers to providing dementia care. The methodological quality of identified studies was assessed using an adapted version of accepted rating criteria for quantitative studies. Data were extracted from studies which were rated as "moderate" or "strong" quality. RESULTS A total of 20 studies were identified, 16 of which were rated as "moderate" or "strong" methodological quality. Patient-related barriers included a reluctance to acknowledge cognitive decline and patient nonadherence to management plans. Provider-related barriers included a lack of training and confidence. System-related barriers included a lack of time during consultations and lack of support services. DISCUSSION AND IMPLICATIONS This review highlights a range of barriers to dementia diagnosis and management from studies rated as being methodologically adequate. Future studies should also utilize theory-driven approaches to exploring a comprehensive range of barriers to optimal dementia care across the care trajectory.
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Affiliation(s)
- Elise Mansfield
- Health Behaviour Research Collaborative, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Natasha Noble
- Health Behaviour Research Collaborative, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Danielle Mazza
- Department of General Practice, Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
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Zwingmann I, Michalowsky B, Esser A, Kaczynski A, Monsees J, Keller A, Hertel J, Wucherer D, Thyrian JR, Eichler T, Kilimann I, Teipel S, Dreier Wolfgramm A, Hoffmann W. Identifying Unmet Needs of Family Dementia Caregivers: Results of the Baseline Assessment of a Cluster-Randomized Controlled Intervention Trial. J Alzheimers Dis 2020; 67:527-539. [PMID: 30584136 PMCID: PMC6398541 DOI: 10.3233/jad-180244] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Caregivers providing informal care for people with dementia (PwD) often report unmet needs, burden, and health impairments. Optimal support for family dementia caregivers will likely benefit from better understanding and assessment of the prevalence and types of caregivers' unmet needs and associated socio-demographic and clinical characteristics. OBJECTIVE The present study investigates 1) the number and types of caregivers' unmet needs, 2) socio-demographic and clinical characteristics of both PwD and caregivers, and 3) caregivers' burden and health-related outcomes that are related to caregivers' unmet needs. METHODS The present analyses are based on cross-sectional data of n = 226 dyads of caregivers and their community-dwelling PwD participating in a comprehensive standardized, computer-based caregivers' needs assessment within a general practitioner (GP)-based, cluster-randomized intervention trial. RESULTS A total of n = 505 unmet needs were identified for n = 171 caregivers from the intervention group at baseline. Only 24.3% caregivers reported no unmet need (n = 55), whereas 75.7% caregivers had at least one unmet need (n = 171). Caregivers had on average 2.19 unmet needs (mean = 2.19, SD = 2.15). Specifically, 53.1% of caregivers had one up to three unmet needs (n = 120), 18.6% (n = 42) had three up to six unmet needs, and 4.0% (n = 9) had more than six unmet needs. DISCUSSION Our results underline the importance of a comprehensive needs assessment for family dementia caregivers to develop and implement concepts that can provide family dementia caregivers with optimal support.
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Affiliation(s)
- Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Alexander Esser
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Anika Kaczynski
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Armin Keller
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Rostock, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Adina Dreier Wolfgramm
- Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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10
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Mason R, Doherty K, Eccleston C, Winbolt M, Long M, Robinson A. Effect of a dementia education intervention on the confidence and attitudes of general practitioners in Australia: a pretest post-test study. BMJ Open 2020; 10:e033218. [PMID: 31988229 PMCID: PMC7044934 DOI: 10.1136/bmjopen-2019-033218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study assessed the impact of a Dementia Education Workshop on the confidence and attitudes of general practitioner (GP) registrars (GPR) and GP supervisors (GPS) in relation to the early diagnosis and management of dementia. DESIGN Pretest post-test research design. SETTING Continuing medical education in Australia. PARTICIPANTS 332 GPR and 114 GPS. INTERVENTIONS Registrars participated in a 3-hour face-to-face workshop while supervisors participated in a 2-hour-modified version designed to assist with the education and supervision of registrars. MAIN OUTCOME MEASURES The General Practitioners Confidence and Attitude Scale for Dementia was used to assess overall confidence, attitude to care and engagement. A t-test for paired samples was used to identify differences from preworkshop (T1) to postworkshop (T2) for each GP group. A t-test for independent samples was undertaken to ascertain differences between each workshop group. A Cohen's d was calculated to measure the effect size of any difference between T1 and T2 scores. RESULTS Significant increases in scores were recorded for Confidence in Clinical Abilities, Attitude to Care and Engagement between pretest and post-test periods. GPR exhibited the greatest increase in scores for Confidence in Clinical Abilities and Engagement. CONCLUSIONS Targeted educational interventions can improve attitude, increase confidence and reduce negative attitudes towards engagement of participating GPs.
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Affiliation(s)
- Ron Mason
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Kathleen Doherty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Claire Eccleston
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Margaret Winbolt
- Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Victoria, Australia
| | - Marita Long
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew Robinson
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
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11
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Diagnoseverfahren bei Patienten mit leichten kognitiven Störungen und bei Patienten mit Demenz. DER NERVENARZT 2019; 91:141-147. [DOI: 10.1007/s00115-019-00829-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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12
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Balogh R, Imre N, Papp E, Kovács I, Heim S, Karádi K, Hajnal F, Pákáski M, Kálmán J. Dementia in Hungary: General practitioners' routines and perspectives regarding early recognition. Eur J Gen Pract 2019; 26:7-13. [PMID: 31601132 PMCID: PMC7006793 DOI: 10.1080/13814788.2019.1673723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Undetected dementia in primary care is a global problem. Since general practitioners (GPs) act as the first step in the identification process, examining their routines could help us to enhance the currently low recognition rates. Objectives: The study aimed to explore, for the first time in Hungary, the dementia identification practices and views of GPs. Methods: In the context of an extensive, national survey (February-November 2014) 8% of all practicing GPs in Hungary (n = 402) filled in a self-administered questionnaire. The questions (single, multiple-choice, Likert-type) analysed in the present study explored GPs’ methods and views regarding dementia identification and their ideas about the optimal circumstances of case-finding. Results: The vast majority of responding GPs (97%) agreed that the early recognition of dementia would enhance both the patients’ and their relatives’ well-being. When examining the possibility of dementia, most GPs (91%) relied on asking the patients general questions and only a quarter of them (24%) used formal tests, even though they were mostly satisfied with both the Clock Drawing Test (69%) and the Mini-Mental State Examination (65%). Longer consultation time was chosen as the most important facet of improvement needed for better identification of dementia in primary care (81%). Half of the GPs (49%) estimated dementia recognition rate to be lower than 30% in their practice. Conclusions: Hungarian GPs were aware of the benefits of early recognition, but the shortage of consultation time in primary care was found to be a major constraint on efficient case-finding.
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Affiliation(s)
- Réka Balogh
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Nóra Imre
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Edina Papp
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Ildikó Kovács
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Szilvia Heim
- Department of Primary Health Care, Medical School, University of Pécs, Pécs, Hungary
| | - Kázmér Karádi
- Institute of Behavioral Sciences, Medical School, University of Pécs, Pécs, Hungary
| | - Ferenc Hajnal
- Department of Family Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Magdolna Pákáski
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - János Kálmán
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
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13
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Carers’ experiences of timely access to and use of dementia care services in eight European countries. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19001119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractTimely access to care services is crucial to support people with dementia and their family carers to live well. Carers of people with dementia (N = 390), recruited from eight countries, completed semi-structured interviews about their experiences of either accessing or not using formal care services over a 12-month period in the Access to Timely Formal Care (Actifcare) study. Participant responses were summarised using content analysis, categorised into clusters and frequencies were calculated. Less than half of the participants (42.3%) reported service use. Of those using services, 72.8 per cent reported timely access and of those not using services 67.2 per cent were satisfied with this situation. However, substantial minorities either reported access at the wrong time (27.2%), or feeling dissatisfied or mixed feelings about not accessing services (32.8%). Reasons for not using services included use not necessary yet, the carer provided support or refusal. Reasons given for using services included changes in the condition of the person with dementia, the service's ability to meet individual needs, not coping or the opportunity to access services arose. Facilitators and barriers to service use included whether participants experienced supportive professionals, the speed of the process, whether the general practitioner was helpful, participant's own proactive attitude and the quality of information received. To achieve timely support, simplified pathways to use of formal care services are needed.
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14
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Düzel E, Thyrian JR, Berron D. [Innovation in diagnostics-mobile technologies]. DER NERVENARZT 2019; 90:914-920. [PMID: 31420690 DOI: 10.1007/s00115-019-0773-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Progressive cognitive deficits are the main clinical symptom of Alzheimer's disease; however, the precise recording of cognitive deficits and assessment of their progression pose major problems in patient care and early interventions. OBJECTIVE Which problems for care and early intervention result from the current practice of cognitive assessment of patients with memory problems and which opportunities arise from the use of mobile apps? MATERIAL AND METHODS Evaluation of current care structures, discussion of basic work, expert recommendations and current developments. RESULTS The current practice of the pencil and paper-based diagnostics of cognitive deficits, which is temporally and spatially bound to a clinical environment, constrains the feasibility, validity and reliability of cognitive assessment and the quantification of progression. This limits the meaningful use of further diagnostic measures, such as magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analyses. Recent progress in mobile app-based technologies, illustrated here with the example of the neotiv app, can help to overcome these problems. CONCLUSION Mobile app-based technologies can help to improve the cognitive assessment of patients with the main symptom of memory complaints. They can reduce overuse and underuse of diagnostic and therapeutic pathways and enable a targeted and meaningful use of advanced diagnostics. In addition, they can structure risk-modifying preventive measures, identify iatrogenic impairment of cognition and in this respect also strengthen patient competence.
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Affiliation(s)
- Emrah Düzel
- Institut für Kognitive Neurologie und Demenzforschung (IKND), Magdeburg, Deutschland. .,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Greifswald, Greifswald, Deutschland.,Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - David Berron
- Institut für Kognitive Neurologie und Demenzforschung (IKND), Magdeburg, Deutschland.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.,Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Schweden
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15
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Thyrian JR, Hertel J, Schulze LN, Dörr M, Prüss H, Hempel P, Bimmler M, Kunze R, Grabe HJ, Teipel S, Hoffmann W. Prevalence and Determinants of Agonistic Autoantibodies Against α1-Adrenergic Receptors in Patients Screened Positive for Dementia: Results from the Population-Based DelpHi-Study. J Alzheimers Dis 2019; 64:1091-1097. [PMID: 30010118 DOI: 10.3233/jad-171096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a need to assess promising biomarkers for diagnosis and treatment response in real-life settings. Despite the important role of vascular risk factors, cardiovascular biomarkers have played a minor role in dementia research. Agonistic autoantibodies (agAAB) directed against G-protein-coupled receptors (GPCR) are discussed as modulators of pathology and clinical manifestation. OBJECTIVE 1) Describe prevalence of agAAB directed against GPCR, especially agABB against α1-adrenergic receptors (α1-AR-agAAB) and agABB directed against β2-adrenergic receptors (β2-AR-agAAB) and 2) identify factors associated with agAAB in people with dementia during routine care. METHODS Blood samples and data from 95 subjects who screened positive for dementia from a primary care cohort, analyzed using an enzyme-linked immunosorbent assay (ELISA) for detecting agAAB. Sociodemographic and clinical data were assessed, and medical records checked. RESULTS In 40 (42%) samples, agAAB was detected, with n = 29 (31%) representing α1-AR-agAAB and n = 21 (22%) β2-AR-agAAB. There was no association between the presence of any antibody and a formal diagnosis of dementia. However, patients with coronary heart disease were more likely (OR = 4.23) to have α1-AR-agAAB than those without coronary heart disease. There were no associations between agAAB and age, sex, education, or cognitive impairment. DISCUSSION For the first time, we show that autoantibodies have a significant prevalence in people with dementia in a routine care setting. Previous findings were restricted to highly selective samples. We replicated the association between α1-AR-agAAB in patients with coronary heart diseases but were not able to find other factors associated with the presence of agAAB.
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16
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Giezendanner S, Monsch AU, Kressig RW, Mueller Y, Streit S, Essig S, Zeller A, Bally K. General practitioners' attitudes towards early diagnosis of dementia: a cross-sectional survey. BMC FAMILY PRACTICE 2019; 20:65. [PMID: 31109304 PMCID: PMC6528190 DOI: 10.1186/s12875-019-0956-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/30/2019] [Indexed: 12/02/2022]
Abstract
BACKGROUND Dementia is often underdiagnosed in general practice, which may be based on general practitioners' (GPs') knowledge and emotional factors as well as external problems. This study aimed to describe GPs' attitudes toward early diagnosis of dementia. METHODS Cross-sectional postal survey in Switzerland in 2017. Members of the Swiss Association of General Practitioners (N = 4460) were asked to participate in the survey. The questionnaire assessed attitudes, enablers and barriers to early dementia diagnosis and post-diagnostic intervention strategies. Exploratory factor analysis and linear regression were used. RESULTS The survey response rate was 21%. 85% of GPs agreed with enablers of early dementia recognition (e.g. "Plan for the future, organize support and care", "Minimize the strain and insecurity of patients and their informal family caregivers"). On the other hand, 15% of respondents perceived barriers towards early dementia recognition (e.g. "Time constraints in carrying out the necessary procedures to diagnose dementia"). GPs who were more likely to agree with barriers would less often counsel family members (β = - 0.05, 95% CI = - 0.09 - -0.02) or test fitness to drive (β = - 0.05, 95% CI = - 0.09 - -0.02), and more often choose a watchful waiting strategy (β = 0.05, 95% CI = 0.02-0.09). CONCLUSIONS The attitude of the majority of GPs is not characterized by diagnostic and therapeutic nihilism. However, negative attitudes were associated with sub-optimal management after the diagnosis. Thus, health systems are required to critically examine the use of available resources allowing GPs to look after patients and their relatives in a holistic way.
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Affiliation(s)
| | - Andreas U. Monsch
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Reto W. Kressig
- University Department of Geriatric Medicine FELIX PLATTER, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Yolanda Mueller
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Stefan Essig
- Institute of Primary and Community Care Lucerne, Lucerne, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Basel, Switzerland
| | - Klaus Bally
- Centre for Primary Health Care, University of Basel, Basel, Basel, Switzerland
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17
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Bentley MW, Kerr R, Ginger M, Karagoz J. Behavioural change in primary care professionals undertaking online education in dementia care in general practice. Aust J Prim Health 2019; 25:244-249. [PMID: 31138397 DOI: 10.1071/py18079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 03/07/2019] [Indexed: 02/28/2024]
Abstract
A challenge facing general practice is improving the diagnosis, management and care of people with dementia. Training and education for primary care professionals about knowledge and attitudes about dementia is needed. Online resources can provide educational opportunities for health professionals with limited access to dementia training. An online educational resource (four modules over 3 h) was designed to assist primary care practitioners to develop a systematic framework to identify, diagnose and manage patients with dementia within their practice. Interviews and questionnaires (knowledge, attitudes, confidence and behavioural intentions), with practice nurses and international medical graduates working in general practices, were used to evaluate the resource. Participants' knowledge, confidence and attitudes about dementia increased after completing the modules. Participants had strong intentions to apply a systematic framework to identify and manage dementia. In post-module interviews, participants reported increased awareness, knowledge and confidence in assessing and managing people with dementia, corroborating the questionnaire results. This project has demonstrated some early changes in clinical behaviour around dementia care in general practice. Promoting the value of applying a systematic framework with colleagues and co-workers could increase awareness of, and participation in, dementia assessment by other primary care professionals within general practices.
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Affiliation(s)
- Michael W Bentley
- General Practice Training Tasmania, Level 3 RACT House, 179 Murray Street, Hobart, Tas. 7000, Australia; and Corresponding author
| | - Rohan Kerr
- General Practice Training Tasmania, Level 3 RACT House, 179 Murray Street, Hobart, Tas. 7000, Australia
| | - Margaret Ginger
- General Practice Training Tasmania, Level 3 RACT House, 179 Murray Street, Hobart, Tas. 7000, Australia
| | - Jacob Karagoz
- Department of Health and Human Services, State Government of Victoria, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia
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18
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Bohlken J, Kostev K. Diagnostic Behavior for Mild Cognitive Impairment in General and Neuropsychiatric Practices in Germany. J Alzheimers Dis 2019; 68:925-930. [PMID: 30883363 DOI: 10.3233/jad-190012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jens Bohlken
- Praxis für Neurologie und Psychiatrie, Berlin, Germany
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19
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Kaczynski A, Michalowsky B, Eichler T, Thyrian JR, Wucherer D, Zwingmann I, Hoffmann W. Comorbidity in Dementia Diseases and Associated Health Care Resources Utilization and Cost. J Alzheimers Dis 2019; 68:635-646. [PMID: 30856111 DOI: 10.3233/jad-180896] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND People with dementia (PwD) suffer from coexisting medical conditions, creating complex clinical challenges and increasing the risk of poor outcomes, which could be associated with high healthcare cost. OBJECTIVE To describe the prevalence of comorbidity in PwD and to analyze the association between comorbidity in dementia diseases and healthcare costs from a payer's perspective. METHODS This cross-sectional analysis was based on n = 362 PwD of the DelpHi-MV trial (Dementia: Life-and person-centered help in Mecklenburg-Western Pomerania). Comorbidity was assessed using the Charlson comorbidity index (CCI) and was categorized into low, high, and very high comorbidity. Healthcare resource utilization and unit costs were used to calculate costs. Multivariable regression models were applied to analyze the association between comorbidity and costs. RESULTS Comorbidity was highly prevalent in the sample. 47% of PwD had a very high, 37% a high, and 16% a low comorbidity in addition to dementia. The most prevalent co-existing comorbidity were diabetes mellitus (42%), peripheral vascular disease (28%) and cerebrovascular disease (25%). Total costs significantly increased by 528€ (SE = 214, CI95 = 109-947, p = 0.014) with each further comorbidity, especially due to higher cost for medication and medical aids. Compared with a low comorbidity, a very high comorbidity was significantly associated with 818€ (SE = 168, CI95 = 489-1147, p < 0.001) higher medication costs and 336€ (SE = 161, CI95 = 20-652, p = 0.037) higher cost for medical aids. There were no significant association between a higher comorbidity and cost for formal care services. CONCLUSIONS Comorbidity in PwD represents a substantial financial burden on healthcare payers and is a challenge for patients, healthcare providers, and the health systems. Innovative approaches are needed to achieve a patient-oriented management of treatment and care in comorbid PwD to reduce long-term costs.
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Affiliation(s)
- Anika Kaczynski
- German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany
| | - Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald (UMG), Greifswald, Germany
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20
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Ulrich LR, Schatz TR, Lappe V, Ihle P, Barthen L, Gerlach FM, Erler A. [Primary and secondary data on dementia care as an example of regional health planning]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 60:1372-1382. [PMID: 29063154 DOI: 10.1007/s00103-017-2642-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health service planning that takes into account as far as possible the regional needs and regional discrepancies is a controversial health issue in Germany. OBJECTIVES In a pilot scheme, we tested a planning process for regional healthcare services, based on the example of dementia care. The aim of this article is to present the strengths and limitations of this planning process. MATERIALS AND METHODS We developed an indicator set for dementia care based on routine regional data obtained from two German statutory health insurance companies. Additionally, primary data based on a questionnaire sent to all GPs in the area were evaluated. These data were expanded through the addition of official socio-demographic population data. Procedures and evaluation strategies, discussion of the results and the derivation of planning measures followed, in close agreement with a group of local experts. RESULTS Few epidemiological data on regional variations in health care planning are publicly available. Secondary data from statutory health insurance companies can be assessed to support the estimation of regional health care needs, but interpretation is difficult. The use of surveys to collect primary data, and the assessment of results by the local health board may facilitate interpretation and may contribute towards more valid statements regarding regional health planning. CONCLUSIONS Despite the limited availability of data and the considerable efforts involved in data analysis, the project demonstrates how needs-based health service planning can be carried out in a small region, taking into account the increasing demands of the local health care providers and the special local features.
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Affiliation(s)
- Lisa-R Ulrich
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
| | - Tanja R Schatz
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - Veronika Lappe
- PMV-Forschungsgruppe, Universität zu Köln, Köln, Deutschland
| | - Peter Ihle
- PMV-Forschungsgruppe, Universität zu Köln, Köln, Deutschland
| | - Linda Barthen
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - Ferdinand M Gerlach
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - Antje Erler
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
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21
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Mason R, Doherty K, Eccleston C, Annear M, Lo A, Tierney L, McInerney F, Robinson A. General practitioners attitude and confidence scale for dementia (GPACS-D): confirmatory factor analysis and comparative subscale scores among GPs and supervisors. BMC FAMILY PRACTICE 2019; 20:6. [PMID: 30621599 PMCID: PMC6323804 DOI: 10.1186/s12875-018-0896-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The attitude of General Practitioner's (GP's) towards dementia and confidence in their clinical abilities impacts on diagnosis rates and management of the condition. The purpose of the present research is to refine and confirm the reliability and validity of the General Practitioner Attitudes and Confidence Scale for Dementia (GPACS-D) as a tool to measure confidence and attitude. METHODS A sample of 194 GP volunteers attending dementia education workshops were recruited to complete the GPACS-D before and after the workshop. Volunteer respondents comprised both GP Registrars and GP Supervisors. Analyses included Confirmatory Factor Analysis (CFA), measures of internal consistency, Pearson correlations, and a comparison of subscale scores between cohorts (T-Test for independent samples). RESULTS Findings of the CFA support a 15-item, 3-factor model with four items removed due to poor performance and one item moved between factors. The resultant model exhibited good fit (x2 = 103.88; p = .105; RMSEA = .032; PCLOSE = .915; CFI = .967; TLI = 960), with acceptable internal consistency. Subscales exhibited clear discriminant validity with no underlying relationships between subscales. Finally, total and subscale scores exhibited good discrimination between groups who would be expected to score differently based on experience and level of exposure to dementia. CONCLUSION The 15-item, 3-subscale GPACS-D is a reliable and valid measure of GP confidence and attitudes toward dementia. The subscales clearly distinguish between groups who might be expected to score differently from each other based on their training or professional experiences. The psychometric properties of the GPACS-D support its use as a research tool.
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Affiliation(s)
- Ron Mason
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania Private Bag 143, Hobart, Tasmania, 7001, Australia.
| | - Kathleen Doherty
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania Private Bag 143, Hobart, Tasmania, 7001, Australia
| | - Claire Eccleston
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania Private Bag 143, Hobart, Tasmania, 7001, Australia
| | - Michael Annear
- Department of Health and Physical Education, International Christian University, 3-10-2 Osawa, Mitaka City, Tokyo, 181-001, Japan
| | - Amanda Lo
- School of Medicine, College of Health and Medicine, University of Tasmania Private Bag 34, Hobart, Tasmania, 7001, Australia
| | - Laura Tierney
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania Private Bag 143, Hobart, Tasmania, 7001, Australia
| | - Fran McInerney
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania Private Bag 143, Hobart, Tasmania, 7001, Australia
| | - Andrew Robinson
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania Private Bag 143, Hobart, Tasmania, 7001, Australia
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22
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Strohmaier U, Keller F, Kilimann I, Michalowsky B, Wucherer D, Zwingmann I, Teipel S, Hoffmann W, Thyrian JR. Patients with Dementia in Primary Care: Who Is Referred to a Neurologist/Psychiatrist and What Patient-Oriented Factors Are Associated with the Visit? J Alzheimers Dis 2018; 64:925-932. [PMID: 29889067 DOI: 10.3233/jad-180196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Urs Strohmaier
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr, Germany
| | - Felix Keller
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany
- Department of Psychosomatic and Psychotherapeutic Medicine, University Medicine Rostock, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr, Germany
| | - Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany
- Department of Psychosomatic and Psychotherapeutic Medicine, University Medicine Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr, Germany
- Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr, Germany
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23
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Thyrian JR, Eichler T, Michalowsky B, Wucherer D, Reimann M, Hertel J, Richter S, Dreier A, Hoffmann W. Community-Dwelling People Screened Positive for Dementia in Primary Care: A Comprehensive, Multivariate Descriptive Analysis Using Data from the DelpHi-Study. J Alzheimers Dis 2017; 52:609-17. [PMID: 27031481 DOI: 10.3233/jad-151076] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Efficient help and care for people with dementia (PWD) is dependent on knowledge about PWD in primary care. OBJECTIVE This analysis comprehensively describes community-dwelling PWD in primary care with respect to various dementia care specific variables. METHODS The analyses are based on baseline data of the ongoing general practitioner-based, randomized, controlled intervention trial DelpHi-MV (Dementia: life- and person-centered help). 6,838 patients were screened for dementia in 136 GP practices; 17.1% were screened positive, 54.4% of those agreed to participate and data could be assessed in n = 516 subjects. We assessed age, sex, living situation, cognitive status, functional status, level of impairment, comorbidities, formal diagnosis of dementia, depression, neuropsychiatric symptoms, quality of life, utilization of medical support, and pharmacological therapy. RESULTS Concerning clinical-, dementia-, and health-related variables, the sample under examination was on average mildly cognitively and functionally impaired (MMSE, m = 22.2; BADL, m = 3.7). A level of care was assigned in 38.0%. Depression was identified in 15.4% and other frequent comorbidities were high blood pressure (83.3%), coronary heart diseases (37.1%), cerebrovascular diseases (22.3%), among others. In 48.6%, neuropsychiatric symptoms were present in a clinically relevant severity. Pharmacological treatment with antidementia medication was received by 25.8% and antidepressant medication by 14.0%. Utilization of services was generally low. CONCLUSION The comprehensive description of people screened positive for dementia in primary care reveals a complex and unique population of patients. They are considerably underdiagnosed and in their majority mildly to moderately affected. More in-depth analyses are needed to study relations, associations and interactions between different variables.
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Affiliation(s)
- Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Melanie Reimann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Steffen Richter
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Adina Dreier
- Institute for Community Medicine, University of Greifswald, Epidemiology of Health Care and Community Health, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, University of Greifswald, Epidemiology of Health Care and Community Health, Greifswald, Germany
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24
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Thyrian JR, Hertel J, Wucherer D, Eichler T, Michalowsky B, Dreier-Wolfgramm A, Zwingmann I, Kilimann I, Teipel S, Hoffmann W. Effectiveness and Safety of Dementia Care Management in Primary Care: A Randomized Clinical Trial. JAMA Psychiatry 2017; 74:996-1004. [PMID: 28746708 PMCID: PMC5710469 DOI: 10.1001/jamapsychiatry.2017.2124] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Dementia care management (DCM) can increase the quality of care for people with dementia. Methodologically rigorous clinical trials on DCM are lacking. OBJECTIVE To test the effectiveness and safety of DCM in the treatment and care of people with dementia living at home and caregiver burden (when available). DESIGN, SETTING, AND PARTICIPANTS This pragmatic, general practitioner-based, cluster-randomized intervention trial compared the intervention with care as usual at baseline and at 12-month follow-up. Simple 1:1 randomization of general practices in Germany was used. Analyses were intent to treat and per protocol. In total, 6838 patients were screened for dementia (eligibility: 70 years and older and living at home) from January 1, 2012, to March 31, 2016. Overall, 1167 (17.1%) were diagnosed as having dementia, and 634 (9.3%) provided written informed consent to participate. INTERVENTIONS Dementia care management was provided for 6 months at the homes of patients with dementia. Dementia care management is a model of collaborative care, defined as a complex intervention aiming to provide optimal treatment and care for patients with dementia and support caregivers using a computer-assisted assessment determining a personalized array of intervention modules and subsequent success monitoring. Dementia care management was targeted at the individual patient level and was conducted by 6 study nurses with dementia care-specific qualifications. MAIN OUTCOMES AND MEASURES Quality of life, caregiver burden, behavioral and psychological symptoms of dementia, pharmacotherapy with antidementia drugs, and use of potentially inappropriate medication. RESULTS The mean age of 634 patients was 80 years. A total of 407 patients received the intended treatment and were available for primary outcome measurement. Of these patients, 248 (60.9%) were women, and 204 (50.1%) lived alone. Dementia care management significantly decreased behavioral and psychological symptoms of dementia (b = -7.45; 95% CI, -11.08 to -3.81; P < .001) and caregiver burden (b = -0.50; 95% CI, -1.09 to 0.08; P = .045) compared with care as usual. Patients with dementia receiving DCM had an increased chance of receiving antidementia drug treatment (DCM, 114 of 291 [39.2%] vs care as usual, 31 of 116 [26.7%]) after 12 months (odds ratio, 1.97; 95% CI, 0.99 to 3.94; P = .03). Dementia care management significantly increased quality of life (b = 0.08; 95% CI, 0 to 0.17; P = .03) for patients not living alone but did not increase quality of life overall. There was no effect on potentially inappropriate medication (odds ratio, 1.86; 95% CI, 0.62 to 3.62; P = .97). CONCLUSIONS AND RELEVANCE Dementia care management provided by specifically trained nurses is an effective collaborative care model that improves relevant patient- and caregiver-related outcomes in dementia. Implementing DCM in different health care systems should become an active area of research. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01401582.
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Affiliation(s)
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany,Department of Psychiatry and Psychotherapy, Greifswald Medical School, University of Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | | | - Adina Dreier-Wolfgramm
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Greifswald Medical School, University of Greifswald, Greifswald, Germany
| | - Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany,Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Greifswald Medical School, University of Greifswald, Greifswald, Germany
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25
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Bieber A, Stephan A, Verbeek H, Verhey F, Kerpershoek L, Wolfs C, de Vugt M, Woods RT, Røsvik J, Selbaek G, Sjölund BM, Wimo A, Hopper L, Irving K, Marques MJ, Gonçalves-Pereira M, Portolani E, Zanetti O, Meyer G. Access to community care for people with dementia and their informal carers : Case vignettes for a European comparison of structures and common pathways to formal care. Z Gerontol Geriatr 2017; 51:530-536. [PMID: 28616816 DOI: 10.1007/s00391-017-1266-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/12/2017] [Accepted: 05/29/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND People with dementia and their informal carers often do not receive appropriate professional support or it is not received at the right time. OBJECTIVES Description and comparison of common pathways to formal community dementia care in eight European countries as a part of the transnational Actifcare project. MATERIALS AND METHODS The German team was responsible for creating an individual case scenario as a starting point. The research teams in Ireland, Italy, the Netherlands, Norway, Portugal, Sweden, and the United Kingdom were then asked to describe a common pathway to formal dementia care by writing their own vignette using the provided individual case scenario. RESULTS A transnational qualitative content analysis was used to identify the following categories as being the most important: involved professionals, dementia-specific and team-based approaches, proactive roles, and financial aspects. General practitioners (GPs) are described as being the most important profession supporting the access to formal care in all the involved countries. In some countries other professionals take over responsibility for the access procedure. Dementia-specific approaches are rarely part of standard care; team-based approaches have differing significances in each of the countries. Informal carers are mainly proactive in seeking formal care. The Nordic countries demonstrate how financial support enhances access to the professional system. CONCLUSION Enhanced cooperation between GPs and other professions might optimize access to formal dementia care. Team-based approaches focusing on dementia care should be developed further. Informal carers should be supported and relieved in their role. Financial barriers remain which should be further investigated and reduced.
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Affiliation(s)
- A Bieber
- Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - A Stephan
- Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - H Verbeek
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - F Verhey
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L Kerpershoek
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C Wolfs
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M de Vugt
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R T Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, UK
| | - J Røsvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, and Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - G Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, and Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - B M Sjölund
- Department of Neurobiology, Care sciences and Society, Karolinska Institut, Stockholm, Sweden.,Department of Health and Caring Services, University of Gävle, Gävle, Sweden
| | - A Wimo
- Department of Neurobiology, Care sciences and Society, Karolinska Institut, Stockholm, Sweden
| | - L Hopper
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - K Irving
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - M J Marques
- CEDOC, Chronic Diseases Research Centre, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - M Gonçalves-Pereira
- CEDOC, Chronic Diseases Research Centre, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - E Portolani
- Alzheimer's Research Unit-Memory Clinic, Brescia, Italy
| | - O Zanetti
- Alzheimer's Research Unit-Memory Clinic, Brescia, Italy
| | - G Meyer
- Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
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26
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Eichler T, Hoffmann W, Hertel J, Richter S, Wucherer D, Michalowsky B, Dreier A, Thyrian JR. Living Alone with Dementia: Prevalence, Correlates and the Utilization of Health and Nursing Care Services. J Alzheimers Dis 2017; 52:619-29. [PMID: 27031480 DOI: 10.3233/jad-151058] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known about the proportion and the characteristics of community-dwelling people with dementia (PWD) living alone in Germany. OBJECTIVES To analyze the prevalence of PWD living alone (with and without the support of an informal caregiver) and socio-demographical and clinical characteristics as well as health and nursing care utilization associated with living alone. METHODS DelpHi-MV (Dementia: Life- and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, randomized controlled intervention trial. The present analyses are based on baseline data of 511 patients (≥70 years, community-dwelling) who had screened positive for dementia (DemTect <9). RESULTS N = 251 (51%) of the patients lived alone. PWD living alone were statistically significantly more often female, older, and more often widowed than those not living alone. About 9% of the patients (n = 24) were not supported by any informal caregiver. Regarding the clinical variables (cognitive and functional impairment, depression, falls, number of drug-related problems, malnutrition, quality of life), there were no statistically significant group differences. Patients living alone utilized professional services such as home care, help with medication, home-delivered meals, or housekeeping assistance significantly more often. Multivariate analyses confirmed these findings. CONCLUSION Our results reveal the high proportion of PWD living alone in Germany. PWD living alone did not seem to be at an increased health risk. Our findings indicate that living alone with dementia is possible. In order to ensure the sufficient provision of health and nursing care services for PWD living alone, providers should consider the present results for future planning.
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Affiliation(s)
- Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.,Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Steffen Richter
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Adina Dreier
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
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27
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Bohlken J, Jacob L, Kostev K. Progression of mild cognitive impairment to dementia in German specialist practices. DEMENTIA 2016; 18:380-390. [PMID: 27758960 DOI: 10.1177/1471301216673919] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The goal of this study was to estimate the rate of the progression of mild cognitive impairment to dementia and identify the potential risk factors in German specialist practices from 2005 to 2015. This study included 4633 patients aged 40 years and over from 203 neuropsychiatric practices, who were initially diagnosed with mild cognitive impairment between 2005 and 2013. The primary outcome was diagnosis of all-cause dementia recorded in the database until the end of the five-year follow-up period. Cox regression models were used to examine mild cognitive impairment progression to dementia when adjusted for confounders (age, sex, and health-insurance type). The mean age was 68.9 years and 46.6% were men. After the five-year follow-up period, 38.1% of women and 30.4% of men had been diagnosed with dementia ( p < 0.001). The share of subjects with dementia increased with age, rising from 6.6% in the age group of ≤ 60 years to 64.7% in the age group of > 80 years ( p < 0.001). Men were at a lower risk of being diagnosed with dementia than women (hazard ratio = 0.86). Patients in the age groups 61-70, 71-80, and > 80 years also had a higher risk of developing this psychiatric disorder, with hazard ratios ranging from 3.50 to 11.71. Finally, mild cognitive impairment was less likely to progress to dementia in people with private health-insurance coverage than in people with public health-insurance coverage (hazard ratio = 0.69). Around one in three patients developed dementia in the five years following mild cognitive impairment diagnosis. Sex, age, and type of health insurance were associated with this risk.
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Affiliation(s)
| | - Louis Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
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28
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Thyrian JR, Winter P, Eichler T, Reimann M, Wucherer D, Dreier A, Michalowsky B, Zarm K, Hoffmann W. Relatives' burden of caring for people screened positive for dementia in primary care : Results of the DelpHi study. Z Gerontol Geriatr 2016; 50:4-13. [PMID: 27534949 DOI: 10.1007/s00391-016-1119-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/14/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a lack of data describing caregiver burden in primary care where most (informal) caregiving is provided. OBJECTIVE The aims of the paper are to describe the burden of people caring for persons with dementia (PWD) in primary care in multiple dimensions and to analyze factors associated with specific dimensions of caregiver burden. MATERIAL AND METHODS Analyses are based on cross-sectional data of the general physician-based, cluster-randomized, controlled intervention trial DelpHi-MV (Dementia: life and person-centered help). A sample of n = 310 community dwelling PWD screened positive for dementia (DemTect < 9) and their caregivers provided sociodemographic and disease-related data, caregiver burden was assessed in 20 dimensions using the Berlin inventory on relatives' burden in dementia (Berliner Inventar zur Angehörigenbelastung - Demenz, BIZA-D). RESULTS Depending on the dimension of objective burden due to caring, between 71.3 % and 92.3 % of the caregivers reported an objective burden. The average burden ranged from 3.68 to 9.81 (scale range 0-16). The subjective burden due to caring ranged from 0.1 to 1.1 (scale range 0-4). Between 22.6 and 51.6 % of our sample indicated burdens due to perceived conflicts. Logistic regression models associating caregiver burden with specifics of PWD and caregivers reached statistical significance for nearly all dimensions of the BIZA-D. Functional and cognitive impairment were statistically significant factors in 12 out of 20 and 5 out of 20 dimensions, respectively. CONCLUSION This is first quantitative in-depth analysis of burden for caregiver of people screened positive for dementia in primary care in Germany. In general, caregiver burden was perceived as being low to moderate by caregivers and lower than reported from other settings.
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Affiliation(s)
- Jochen René Thyrian
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany.
| | - Paula Winter
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Melanie Reimann
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Adina Dreier
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Katja Zarm
- German Center for Neurodegenerative Diseases, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Universitymedicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
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29
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Depressive symptoms and depression in people screened positive for dementia in primary care - results of the DelpHi-study. Int Psychogeriatr 2016; 28:929-37. [PMID: 26785854 DOI: 10.1017/s1041610215002458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dementia and depression are common syndromes in the elderly. There is lack of knowledge concerning the frequency of depressive symptoms in people with dementia (PWD) and factors associated with depression. The aim of this analysis is to (a) describe the frequency of depressive symptoms in people screened positive for dementia, (b) describe differences between PWD with and without depressive symptoms, and (c) analyze associations between depressive symptoms and other dementia-related variables. METHODS Analyses are based on data of the GP-based intervention trial DelpHi-MV. A sample of 430 (6.29%) people screened positive for dementia in primary care was analyzed regarding depression according to the German version of the Geriatric Depression Scale (GDS, 15-items), demographic variables, and dementia/depression-related variables. Multivariate analyses were conducted to identify factors associated with depressive symptoms. RESULTS The mean GDS-score of depressive symptoms in n = 430 PWD was m = 3.21 (SD 2.45) with 67 PWD (15.55%) showing clinically relevant depression (GDS < 5) m = 7.71 (SD = 1.92). A total of n = 72 (16.74%) received a formal diagnosis of depression and n = 62 (14.42%) received antidepressive drug treatment. Depressive symptoms are significantly associated with age (OR = 0.93), functional impairment (OR = 1.36), and quality of life (OR = 0.01, CI: 0.00-0.06). CONCLUSION Our results support previous findings that clinically relevant depressive symptoms are more common in people screened positive for dementia than in the general population and are often missed or mismanaged. Our findings underline the importance of managing quality of life, functional status, or depressive symptoms. Also, the results highlight the benefit of including the partner (and probably other carers) for adequate treatment of PWD.
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30
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Thyrian JR, Eichler T, Pooch A, Albuerne K, Dreier A, Michalowsky B, Wucherer D, Hoffmann W. Systematic, early identification of dementia and dementia care management are highly appreciated by general physicians in primary care - results within a cluster-randomized-controlled trial (DelpHi). J Multidiscip Healthc 2016; 9:183-90. [PMID: 27143912 PMCID: PMC4844257 DOI: 10.2147/jmdh.s96055] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background There is evidence about the benefits of early detection of dementia and subsequent provision of adequate treatment and care. However, there is a lack of knowledge about the acceptance of detection and intervention procedures. These analyses describe the attitudes of general physicians [GPs] toward 1) dementia in general, 2) systematic detection of people with dementia, and 3) an intervention approach after they have experienced both. Comparisons are made based on experience with systematic screening and dementia-specific intervention. Methods Postal, cross-sectional survey to all n=1,252 GPs in the Mecklenburg-Western Pomerania, Germany. A subsample was drawn based on participation in the randomized, controlled, prospective intervention DelpHi-MV trial (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania). In this trial, systematic screening is implemented and an intervention group receives support through dementia care management (DCM). GPs were categorized into either GPs with DCM and systematic screening (DCM-GP), GPs with systematic screening only (DelpHi-GP), or GPs not participating in the trial. Data from n=257 GPs were available. Attitudes toward dementia were assessed using a validated questionnaire. Results There was strong agreement toward the helpfulness of implementing a brief cognitive screening test (89.9% agreed). Approximately two-thirds of the respondents indicated that they had identified at least some patients as being cognitively impaired for the first time. The majority of the respondents indicated agreement toward DCM. It was described as supportive and helpful. The qualified nurses were perceived as competent in dementia care and 79.3% would like to be supported with DCM. Attitudes toward dementia are positive and do not differ between groups. Conclusion The results indicate that early recognition and DCM is highly appreciated by GPs and is considered feasible or wanted to be implemented in routine care.
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Affiliation(s)
- Jochen René Thyrian
- German Center for Neurode-generative Diseases (DZNE), Site Greifswald, WG Interventional Health Care Research, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurode-generative Diseases (DZNE), Site Greifswald, WG Interventional Health Care Research, Greifswald, Germany
| | - Andrea Pooch
- German Center for Neurode-generative Diseases (DZNE), Site Greifswald, WG Interventional Health Care Research, Greifswald, Germany
| | - Kerstin Albuerne
- German Center for Neurode-generative Diseases (DZNE), Site Greifswald, WG Interventional Health Care Research, Greifswald, Germany
| | - Adina Dreier
- Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurode-generative Diseases (DZNE), Site Greifswald, WG Interventional Health Care Research, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurode-generative Diseases (DZNE), Site Greifswald, WG Interventional Health Care Research, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurode-generative Diseases (DZNE), Site Greifswald, WG Interventional Health Care Research, Greifswald, Germany; Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University of Greifswald, Greifswald, Germany
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31
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López-Díaz JA, Ruíz-Díaz G, Ortega-Blanco JA. [A case of Huntington disease in primary care: The role of the physician]. Semergen 2016; 42:e157-e159. [PMID: 26924685 DOI: 10.1016/j.semerg.2016.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Affiliation(s)
- J A López-Díaz
- Medicina de Familia y Comunitaria, Centro de Salud Molino de la Vega, Huelva, España.
| | - G Ruíz-Díaz
- Medicina de Familia y Comunitaria, Centro de Salud Molino de la Vega, Huelva, España
| | - J A Ortega-Blanco
- Medicina de Familia y Comunitaria, Centro de Salud Molino de la Vega, Huelva, España
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Eichler T, Thyrian JR, Hertel J, Wucherer D, Michalowsky B, Reiner K, Dreier A, Kilimann I, Teipel S, Hoffmann W. Subjective memory impairment: No suitable criteria for case-finding of dementia in primary care. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2015; 1:179-86. [PMID: 27239503 PMCID: PMC4876911 DOI: 10.1016/j.dadm.2015.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
INTRODUCTION Subjective memory impairment (SMI) might be used for the case-finding of dementia. Present analyses aim to determine the diagnostic value and the predictive ability of SMI and related worries for the discrimination of patients screened positive or negative for dementia. METHODS The analyses are based on data derived from the ongoing German general practioner (GP)-based, randomized controlled trial DelpHi-MV. A total of 5106 patients (age ≥ 70, living at home) were first asked for SMI and related worries and then screened for dementia in 110 participating GP practices (November 2011 to August 2014; preliminary data) using the DemTect. RESULTS A total number of 2556 patients (50%) stated that they experience SMI and 892 patients (17%) screened positive for dementia. The sensitivity of SMI for the correct classification of positively screened patients was 54%, the positive predictive value (PPV) 19%. The specificity of SMI was 51%; the negative predictive value (NPV) 84%. Among 2480 patients with SMI, 45% reported SMI-related worries (sensitivity 52%; specificity 57%; PPV 22%; NPV 84%). Receiver operating characteristics analyses showed no statistically significant improvement in the area under the curves when using SMI or related worries as predictors (additional to age and sex) for the discrimination between positively and negatively screened patients. DISCUSSION The analyses showed that the risk of overlooking cognitive impairment in the subgroup of patients who state that they do not experience SMI would be unreasonable high. Thus, the results provide clear evidence that neither SMI nor related worries can be used as a valid criteria to decide whether an elderly primary care patient should be tested for dementia. TRIALS REGISTRATION ClinicalTrials.gov Identifier: NCT01401582.
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Affiliation(s)
- Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | | | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | | | - Katinka Reiner
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Adina Dreier
- Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
- Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Eichler T, Thyrian JR, Hertel J, Michalowsky B, Wucherer D, Dreier A, Kilimann I, Teipel S, Hoffmann W. Rates of formal diagnosis of dementia in primary care: The effect of screening. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2015; 1:87-93. [PMID: 27239495 PMCID: PMC4876881 DOI: 10.1016/j.dadm.2014.11.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Screening could improve recognition of dementia in primary care. We sought to determine the effect of screening for dementia in primary care practices on the formal diagnosis rate; the distribution of differential diagnoses; and the factors associated with receiving a formal diagnosis. METHODS The "Dementia: life- and person-centered help in Mecklenburg-Western Pomerania" is an ongoing general practitioner (GP)-based, randomized, controlled intervention trial. A total of 4064 community dwelling patients (aged ≥70 years) were screened for dementia in 108 GP practices. Of these patients, 692 (17%) had positive screening results (DemTect score <9). Of these 692 patients, 406 (59%) provided informed consent. The analyses included the data from 243 patients with a complete baseline assessment (preliminary data; January 2014). RESULTS Of 146 patients without a formal diagnosis of dementia, 72 (49%) received a formal diagnosis after a positive screening outcome (69% with "unspecified dementia"). Female sex was significantly associated with receiving a formal diagnosis (multivariate analyses). CONCLUSION Screening improved the identification of dementia considerably. Because of the risk of receiving a false-positive diagnosis, additional diagnostic assessment should be mandatory.
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Affiliation(s)
- Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Adina Dreier
- Institute for Community Medicine, Section of Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
- Institute for Community Medicine, Section of Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
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The benefits of implementing a computerized intervention-management-system (IMS) on delivering integrated dementia care in the primary care setting. Int Psychogeriatr 2014; 26:1377-85. [PMID: 24811145 DOI: 10.1017/s1041610214000830] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND A computerized Intervention-Management-System (IMS) has been developed and implemented to facilitate dementia care management. IMS is a rule-based expert decision support system that matches individual patient characteristics to a computerized knowledge base. One of the most important functionalities of IMS is to support the compilation of the individual intervention plan by systematically identifying unmet needs and suggesting the corresponding specific interventions for recommendation to the general practitioner (GP). The present analysis aimed to determine if the implementation of IMS improves the identification of unmet needs and the recommendation of adequate specific interventions. In addition, the feasibility and acceptability of the IMS were evaluated. METHODS Delphi-MV is an on-going GP-based, cluster-randomized, controlled intervention trial to implement and evaluate a collaborative dementia care management program for community-dwelling PWDs and their caregivers. IMS was developed and implemented over the course of the DelpHi-trial. The identified unmet needs and the interventions that were recommended to the GP before and after the implementation of IMS were compared. To evaluate the feasibility and acceptability of the IMS, a survey was conducted among the current users of IMS. RESULTS AND CONCLUSIONS After the implementation of IMS, the number of specific interventions recommended to the GP increased by 85%. Our findings provide evidence that IMS improves the systematic identification of unmet needs and the subsequent recommendation of interventions to address these needs. The users evaluated IMS as very helpful and would like to use it for their future work. However, the usability could be further improved.
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Sikorski C, Luppa M, Glaesmer H, Brähler E, König HH, Riedel-Heller SG. Attitudes of health care professionals towards female obese patients. Obes Facts 2013; 6:512-22. [PMID: 24296724 PMCID: PMC5644724 DOI: 10.1159/000356692] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 08/03/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The health care setting has been reported to be one main source of weight stigma repeatedly; however, studies comparing different professions have been lacking. METHODS 682 health care professionals (HCP) of a large German university hospital were asked to fill out a questionnaire on stigmatizing attitudes, perceived causes of obesity, and work-related impact of obesity. Stigmatizing attitudes were assessed on the Fat Phobia Scale (FPS) based on a vignette describing a female obese patient. RESULTS Only 25% graded current health care of obese patients to be 'good' or 'very good'. 63% of all HCPs 'somewhat' or 'strongly' agreed that it was often difficult to get the resources needed in order to care for obese patients. The mean FPS score was comparable to that in the general public (M = 3.59), while nursing staff showed slightly more positive attitudes compared to physicians and therapists. Higher age, higher BMI, and ascribing personal responsibility for obesity to the individual were associated with a higher level of stigmatizing attitudes. The nursing staff agreed on obesity as an illness to a greater extent while physicians attributed obesity to the individual. CONCLUSIONS In summary, by making complex models on the causes of obesity known among health care professionals, stigmatizing attitudes might be reduced. Ongoing further education for health care professionals ought to be part of anti-stigma campaigns in the medical field.
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Affiliation(s)
- Claudia Sikorski
- Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Hamburg, Germany
- Institute of Social Medicine, Occupational Health and Public Health, Hamburg, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, Hamburg, Germany
| | - Heide Glaesmer
- Institute of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Hamburg, Germany
| | - Elmar Brähler
- Institute of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Hamburg, Germany
| | - Hans-Helmut König
- Department of Medical Sociology and Health Economics, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
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