Rickey E Carter1, Del A Rose, Yuko Y Palesch, Jacobo E Mintzer. 1. Department of Biometry and Epidemiology and the Institute of Psychiatry , Medical University of South Carolina, Charleston; the Partnership & Support Network, Mt. Olivet Rolling Acres, Victoria, Minn. ; and The Clinical Innovation Group, MUSC Foundation for Research Development, Charleston, S.C. .
Abstract
BACKGROUND: The prevalence of Alzheimer's disease (AD) is approximately 4.5 million people in the United States, and it is projected that by 2050, the prevalence could be as high as 16 million. As one step to minimize this health care burden, we investigated the practices of primary care physicians (PCPs) to determine barriers to and incentives in diagnosing AD and assessed the feasibility of utilizing a caregiver-based phone interview for dementia in the primary care setting. METHOD: This feasibility study was conducted in 2 phases. Phase I included PCP focus groups conducted to identify barriers and incentives to diagnosis of Alzheimer's disease, knowledge of available screening instruments, and current diagnostic procedures and patterns. A survey of a random sample of PCPs was also conducted to reassess the data obtained via the focus groups. Phase II assessed the feasibility of implementing a brief, caregiver-based dementia screening tool in the primary care setting. A participant's score on the screening tool was compared with the PCP's clinical impression using the kappa statistic. RESULTS: A general willingness exists among PCPs to improve the level of care for patients with AD; however, time constraints are a sizeable barrier in the PCP setting. The incorporation of a telephone-based (or caregiver-based) assessment is feasible. The agreement between the caregiver ratings and the PCPs' clinical impressions was kappa = 0.64 (95% CI = 0.19 to 1.0). CONCLUSION: The caregiver-based telephone assessment has indications of good agreement with the PCP's general assessment of dementia or possible AD. The limited number of patients with positive screens hinders generalization of this phase of the study, but the results confirm the potential value of caregiver-based assessment and the desirability of a larger study to address the scientific properties of a telephone-based screening instrument.
BACKGROUND: The prevalence of Alzheimer's disease (AD) is approximately 4.5 million people in the United States, and it is projected that by 2050, the prevalence could be as high as 16 million. As one step to minimize this health care burden, we investigated the practices of primary care physicians (PCPs) to determine barriers to and incentives in diagnosing AD and assessed the feasibility of utilizing a caregiver-based phone interview for dementia in the primary care setting. METHOD: This feasibility study was conducted in 2 phases. Phase I included PCP focus groups conducted to identify barriers and incentives to diagnosis of Alzheimer's disease, knowledge of available screening instruments, and current diagnostic procedures and patterns. A survey of a random sample of PCPs was also conducted to reassess the data obtained via the focus groups. Phase II assessed the feasibility of implementing a brief, caregiver-based dementia screening tool in the primary care setting. A participant's score on the screening tool was compared with the PCP's clinical impression using the kappa statistic. RESULTS: A general willingness exists among PCPs to improve the level of care for patients with AD; however, time constraints are a sizeable barrier in the PCP setting. The incorporation of a telephone-based (or caregiver-based) assessment is feasible. The agreement between the caregiver ratings and the PCPs' clinical impressions was kappa = 0.64 (95% CI = 0.19 to 1.0). CONCLUSION: The caregiver-based telephone assessment has indications of good agreement with the PCP's general assessment of dementia or possible AD. The limited number of patients with positive screens hinders generalization of this phase of the study, but the results confirm the potential value of caregiver-based assessment and the desirability of a larger study to address the scientific properties of a telephone-based screening instrument.
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