Confidence in diagnosing and managing care for cognitive impairment in primary care: a survey comparing barriers by primary care clinician type.

Autor:	JaKa MM; Center for Evaluation and Survey Research, HealthPartners Institute, Bloomington, 55425, United States., Rossom RC; HealthPartners Institute, Bloomington, 55425, United States., Borson S; Department of Family Medicine, Keck USC School of Medicine, Los Angeles, 90033, United States., O'Connor PJ; HealthPartners Institute, Bloomington, 55425, United States., Zibley LJ; Center for Evaluation and Survey Research, HealthPartners Institute, Bloomington, 55425, United States., von Sternberg TL; HealthPartners, Bloomington, 55425, United States., Crain AL; HealthPartners Institute, Bloomington, 55425, United States., Ekstrom HL; HealthPartners Institute, Bloomington, 55425, United States., Crouse B; HealthPartners Institute, Bloomington, 55425, United States., Werner AM; HealthPartners Institute, Bloomington, 55425, United States., Hanson LR; HealthPartners Institute, Bloomington, 55425, United States.
Jazyk:	angličtina
Zdroj:	Family practice [Fam Pract] 2024 Oct 08; Vol. 41 (5), pp. 761-769.
DOI:	10.1093/fampra/cmae043
Abstrakt:	Background: As cognitive impairment (CI) prevalence rises and primary care screening becomes commonplace, it is critical to understand how to support clinicians. We describe clinician-reported barriers to diagnosing and managing care for patients with CI in a health system with standardized screening. We also explore whether barriers differ by clinician type-physician or advanced-practice clinician (APC). Methods: Theory-informed surveys were administered to primary care clinicians in a large integrated health system. The survey assessed barriers, confidence in diagnosing CI and managing CI care, beliefs about the consequences of diagnosing CI, and usability of the electronic health record (EHR) to diagnose and manage CI care; it also included open-ended response items. Descriptive statistics and content analysis were used to describe perceived barriers. Differences by clinician type were compared using chi-square. Results: Of the 408 eligible clinicians, 249 started the survey and 247 completed the primary outcomes (61% response rate). Many said they were only a little or not at all confident in diagnosing (70%) and managing care for (60%) CI, with specific gaps in confidence in distinguishing types of dementia and having CI-related conversations with patients or family/care partners. APCs reported lower confidence than physicians. Other barriers were lack of time, low usability of EHR, and lack of family/care partner availability. These did not differ by clinician type. Open-ended responses suggest clinicians would like more support for CI care. Conclusion: Low levels of confidence among other barriers suggest an urgent need to develop and implement effective multifaceted strategies to improve CI care. (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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