Patients with Dementia in Primary Care: Who Is Referred to a Neurologist/Psychiatrist and What Patient-Oriented Factors Are Associated with the Visit?
| Autor: | Jochen René Thyrian, Urs Strohmaier, Bernhard Michalowsky, Diana Wucherer, Ina Zwingmann, Ingo Kilimann, Felix Keller, Wolfgang Hoffmann, Stefan J. Teipel |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Tomography Scanners X-Ray Computed Multivariate analysis Activities of daily living Neurology Neuropsychological Tests therapy [Dementia] 03 medical and health sciences 0302 clinical medicine Bayesian multivariate linear regression Activities of Daily Living medicine Humans Dementia ddc:610 diagnostic imaging [Dementia] Neurologists 030212 general & internal medicine Referral and Consultation Depression (differential diagnoses) Aged Aged 80 and over Psychiatry methods [Primary Health Care] Primary Health Care business.industry General Neuroscience Medical record General Medicine medicine.disease Magnetic Resonance Imaging Confidence interval Psychiatry and Mental health Clinical Psychology Family medicine statistics & numerical data [Primary Health Care] Female Geriatrics and Gerontology business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Alzheimer's disease 64(3), 925-932 (2018). doi:10.3233/JAD-180196 |
| ISSN: | 1875-8908 1387-2877 |
| DOI: | 10.3233/jad-180196 |
| Popis: | Background The current guidelines imply that basic medical diagnostics for dementia should be provided by general practitioners in cooperation with other specialists such as neurologists and psychiatrists. Objectives The aims of this paper were to 1) compare the dementia patients of general practice residents whose care is co-managed by neurology/psychiatry residents with those whose care is not; 2) identify the patient variables associated with the utilization of neurological and psychiatric specialists; and 3) describe the frequency of imaging used for dementia patients in primary care. Methods The analyses utilized data from 485 individuals who screened positive for dementia in primary care (PWD). Clinical variables and the utilization of specialists were assessed via medical records and face-to-face interviews. The factors associated with the utilization of specialists were assessed using multivariate linear regression and included age, sex, relationship status, cognitive impairment, depression, activities of daily living, and formal diagnosis of dementia. Results Our results show that 89 out of 485 study participants (18.4%) were referred to specialists 12 months prior to assessment. Of these 89 individuals, 14.6% (n = 13) did not receive imaging diagnostics, while 39.3% (n = 35) received brain imaging by CT scan and 46.1% (n = 41) by MRI. PWD referred to specialists differed from those not referred, in age, relationship status, and the presence of a formal diagnosis. Our multivariate analysis revealed that younger age (OR = 0.95; 95% -confidence interval 0.90-0.99; p = 0.04) and higher functional impairment (OR = 1.15; 95% -confidence interval 1.02-1.30; p = 0.02) were associated with a visit to a specialist. Discussion Only 1 out of every 4 to 5 individuals who have screened positive for dementia have visited a specialist in psychiatry or neurology. While in general, women utilized specialists less often than men, younger and more functionally impaired patients were more likely to be sent to a specialist by their treating general practitioner. Almost 90% of the patients sent to a specialist received cranial neuroimaging, suggesting high adherence to diagnostic guidelines in specialized care. |
| Databáze: | OpenAIRE |
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