Ferdinando Petrazzuoli1, Shlomo Vinker2, Tuomas H Koskela3, Thomas Frese4, Nicola Buono5, Jean Karl Soler6, Jette Ahrensberg7, Radost Asenova8, Quintí Foguet Boreu9, Gülsen Ceyhun Peker10, Claire Collins11, Miro Hanževački12, Kathryn Hoffmann13, Claudia Iftode14, Donata Kurpas15, Jean Yves Le Reste16, Bjørn Lichtwarck17, Davorina Petek18, Daniel Pinto19, Diego Schrans20, Sven Streit21, Eugene Yee Hing Tang22, Athina Tatsioni23, Péter Torzsa24, Pemra C Unalan25, Harm van Marwijk26, Hans Thulesius1. 1. Department of Clinical Sciences in Malmö,Centre for Primary Health Care Research,Lund University,Malmö,Sweden. 2. Department of Family Medicine,Sackler School of Medicine,Tel Aviv University,Tel Aviv,Israel. 3. Omapihlaja Health Centre,University of Tampere,Tampere,Finland. 4. Institute of General Practice and Family Medicine,Medical Faculty,Martin-Luther-University Halle-Wittenberg,Halle/Saale,Germany. 5. SNAMID (National Society of Medical Education in General Practice),Caserta,Italy. 6. Mediterranean Institute of Primary Care,Attard,Malta. 7. Research Unit for General Practice,University of Aarhus,Aarhus,Denmark. 8. Department of General Practice,Medical University of Plovdiv,Plovdiv,Bulgaria. 9. Institut Universitari d'Investigació en Atenció Primària- IDIAP Jordi Gol,Universitat Autònoma de Barcelona,Catalonia,Spain. 10. Ankara University School of Medicine,Department of Family Medicine,Ankara,Turkey. 11. Irish College of General Practitioners,Dublin,Ireland. 12. Director Health Care Center of Zagreb,Zagreb,Croatia. 13. Department of General Practice and Family Medicine,Center for Public Health,Medical University of Vienna,Vienna,Austria. 14. Timis Society of Family Medicine,Timisoara,Romania. 15. Family Medicine Department,Wroclaw Medical University,Wroclaw,Poland. 16. Equipe D'accueil SPURBO. Department of General Practice,Université de Bretagne occidentale,Brest,France. 17. Centre for Old Age Psychiatric Research,Innlandet Hospital Trust,Ottestad,Norway. 18. Department of Family medicine,Faculty of Medicine,University of Ljubljana,Ljubljana,Slovenia. 19. Department of Family Medicine,NOVA Medical School,Lisbon,Portugal. 20. Department of Family Medicine and Primary Health Care Ghent University,Ghent,Belgium. 21. Institute of Primary Health Care (BIHAM),University of Bern,Bern,Switzerland. 22. Institute of Health & Society,Newcastle University,Newcastle,UK. 23. Department of Internal Medicine,General Medicine,Faculty of Medicine,University of Ioannina School of Health Sciences,Ioannina,Greece. 24. Department of Family Medicine,Faculty of Medicine,Semmelweis University,Budapest,Hungary. 25. Department of Family Medicine,Marmara University Medical Faculty,Istanbul,Turkey. 26. Centre for Primary Care,Division of Population Health,Health Services Research and Primary Care,School of Health Sciences,Faculty of Biology,Medicine and Health,The University of Manchester,Manchester,UK.
Abstract
BACKGROUND: Strategies for the involvement of primary care in the management of patients with presumed or diagnosed dementia are heterogeneous across Europe. We wanted to explore attitudes of primary care physicians (PCPs) when managing dementia: (i) the most popular cognitive tests, (ii) who had the right to initiate or continue cholinesterase inhibitor or memantine treatment, and (iii) the relationship between the permissiveness of these rules/guidelines and PCP's approach in the dementia investigations and assessment. METHODS: Key informant survey. SETTING: Primary care practices across 25 European countries. SUBJECTS: Four hundred forty-five PCPs responded to a self-administered questionnaire. Two-step cluster analysis was performed using characteristics of the informants and the responses to the survey. MAIN OUTCOME MEASURES: Two by two contingency tables with odds ratios and 95% confidence intervals were used to assess the association between categorical variables. A multinomial logistic regression model was used to assess the association of multiple variables (age class, gender, and perceived prescription rules) with the PCPs' attitude of "trying to establish a diagnosis of dementia on their own." RESULTS: Discrepancies between rules/guidelines and attitudes to dementia management was found in many countries. There was a strong association between the authorization to prescribe dementia drugs and pursuing dementia diagnostic work-up (odds ratio, 3.45; 95% CI 2.28-5.23). CONCLUSIONS: Differing regulations about who does what in dementia management seemed to affect PCP's engagement in dementia investigations and assessment. PCPs who were allowed to prescribe dementia drugs also claimed higher engagement in dementia work-up than PCPs who were not allowed to prescribe.
BACKGROUND: Strategies for the involvement of primary care in the management of patients with presumed or diagnosed dementia are heterogeneous across Europe. We wanted to explore attitudes of primary care physicians (PCPs) when managing dementia: (i) the most popular cognitive tests, (ii) who had the right to initiate or continue cholinesterase inhibitor or memantine treatment, and (iii) the relationship between the permissiveness of these rules/guidelines and PCP's approach in the dementia investigations and assessment. METHODS: Key informant survey. SETTING: Primary care practices across 25 European countries. SUBJECTS: Four hundred forty-five PCPs responded to a self-administered questionnaire. Two-step cluster analysis was performed using characteristics of the informants and the responses to the survey. MAIN OUTCOME MEASURES: Two by two contingency tables with odds ratios and 95% confidence intervals were used to assess the association between categorical variables. A multinomial logistic regression model was used to assess the association of multiple variables (age class, gender, and perceived prescription rules) with the PCPs' attitude of "trying to establish a diagnosis of dementia on their own." RESULTS: Discrepancies between rules/guidelines and attitudes to dementia management was found in many countries. There was a strong association between the authorization to prescribe dementia drugs and pursuing dementia diagnostic work-up (odds ratio, 3.45; 95% CI 2.28-5.23). CONCLUSIONS: Differing regulations about who does what in dementia management seemed to affect PCP's engagement in dementia investigations and assessment. PCPs who were allowed to prescribe dementia drugs also claimed higher engagement in dementia work-up than PCPs who were not allowed to prescribe.
Entities:
Keywords:
Alzheimer's disease; dementia; primary care
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Authors: Ferdinando Petrazzuoli; Shlomo Vinker; Sebastian Palmqvist; Patrik Midlöv; Jan De Lepeleire; Alessandro Pirani; Thomas Frese; Nicola Buono; Jette Ahrensberg; Radost Asenova; Quintí Foguet Boreu; Gülsen Ceyhun Peker; Claire Collins; Miro Hanževački; Kathryn Hoffmann; Claudia Iftode; Tuomas H Koskela; Donata Kurpas; Jean Yves Le Reste; Bjørn Lichtwarck; Davorina Petek; Diego Schrans; Jean Karl Soler; Sven Streit; Athina Tatsioni; Péter Torzsa; Pemra C Unalan; Harm van Marwijk; Hans Thulesius Journal: Scand J Prim Health Care Date: 2020-07-28 Impact factor: 2.581
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