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P2‐251: Cognitive impairment in primary care: Practice patterns and attitudes compared to neurology
Author(s) -
Acosta Lealani Mae,
Romano Raymond,
Jefferson Angela L.
Publication year - 2015
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2015.06.792
Subject(s) - specialty , referral , medicine , primary care , family medicine , cognitive impairment , neurology , cognition , clinical practice , psychiatry
Background: Neurologists’ practice patterns and attitudes regarding diagnosing and treating mild cognitive impairment (MCI) have been explored previously (Roberts et al., 2010), but similar data about primary care provider (PCP) practice patterns and attitudes have not been reported. Because neurologists primarily receive referrals from PCPs, there is a need to assess how PCPs approach diagnosis, treatment, and specialty referrals of patients withMCI to determine any differences in practice patterns, including how to address such differences. We hypothesized that PCPs would vary from neurologists regarding both attitudes towards and treatment of MCI. Methods: A survey (in both email and postal mail format) was distributed to 1274 PCPs (physicians 80%, physician assistants 20%) in the greater Nashville area. The survey included portions of the survey originally sent to neurologists in the Roberts et al., 2010 study (e.g., counseling and attitudes towardsMCI) and original questions about referral practices (e.g., different clinical vignettes prompting referrals). Results:Our survey response rate was low (6.6%) compared to the Roberts et al., 2010 survey (48%). When comparing responses to questions administered in both surveys, Fisher’s exact test results suggested neurologists and PCPs have strikingly similar attitudes about the benefits and drawbacks of making the diagnosis ofMCI (all p-values>0.09). Conversely, out of 13 counseling practices (e.g., support services, diet/nutrition), the PCPs differed from neurologists on 12 of these items (p<0.05), ranging from prescribing medication to counseling about other aspects of health. The only different counseling practice was providing awritten summary to the patient, which just missed the a priori threshold for significance (p1⁄40.06). Conclusions: MCI may serve as a key point of intervention to delay progression to dementia, so early identification and treatment of these patients is crucial. These survey results demonstrate a disparity between PCPs and neurologists regarding how best to care for MCI patients, a finding that needs to be addressed to provide optimal care to this growing patient population, including appropriate referral for a more specialized memory loss work-up.