Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-22T18:53:13.976Z Has data issue: false hasContentIssue false
  • English
  • Français

Educating primary care physicians in the management of Alzheimer's disease: using practice guidelines to set quality benchmarks

Published online by Cambridge University Press:  01 April 2009

Debra L. Cherry ,
Carol Hahn  and
Barbara G. Vickrey
Debra L. Cherry*
Affiliation:
Alzheimer's Association, Los Angeles, California, U.S.A.
Carol Hahn
Affiliation:
Alzheimer's Association, Los Angeles, California, U.S.A.
Barbara G. Vickrey
Affiliation:
Department of Neurology, UCLA, Los Angeles, California, U.S.A.
*
Correspondence should be addressed to: Debra L. Cherry, Alzheimer's Association, 5900 Wilshire Blvd., Los Angeles 90036, U.S.A. Phone: +1 323 930 6225; Fax: +1 323 938 1036. Email: [email protected]
Get access

Abstract

This paper presents a strategy for training primary care physicians in the identification, diagnosis and management of Alzheimer's disease and related disorders. The strategy uses evidence-based practice guidelines to establish quality benchmarks and then provides training and other interventions to improve the quality of care received by these patients. The three projects described in this paper assumed that training of primary care physicians alone would not be sufficient to achieve the quality benchmarks derived from guidelines. The projects used creative training strategies supplemented by provider “tool kits”, provider checklists, educational detailing, and endorsement from organizational leadership to reinforce what the primary care providers learned in educational sessions. Each project also implemented a system of dementia care management to “wrap around” traditional primary care to ensure that quality benchmarks would be achieved. Outcomes of two completed studies support the premise that it is possible to improve quality of dementia care through physician education that occurs in association with a coordinated system of dementia care management and in collaboration with community agencies to access guideline-recommended social services.

Keywords

dementiacare managementtrainingmedical care
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Supplement S1: International perspectives on dementia education, training and knowledge transfer , April 2009 , pp. S44 - S52
Copyright
Copyright © International Psychogeriatric Association 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alzheimer's Association (2008). Alzheimer's Disease: Facts and Figures. Chicago: Alzheimer's Association.Google Scholar
ACCESS Project (2001). Alzheimer's Disease Coordinated Care for San Diego Seniors (updated 7 June 2007). Available at: http://www.adc.ucla.edu/access/access.swf; last accessed 10 October 2008.Google Scholar
American Medical Association (1999). Diagnosis, Management and Treatment of Dementia: A Practical Guide for Primary Care Physicians. Chicago: AMA.Google Scholar
Boise, L., Neil, M. B. and Kaye, J. (2004). Dementia assessment in primary care: results from a study in three managed care systems. Journal of Gerontology, 59A, 621–626.Google Scholar
Boise, L., Camiciolo, R., Morgan, D. L., Rose, J. H. and Congleton, L. (1999). Diagnosing dementia: perspectives of primary care physicians. The Gerontologist, 39, 457–494.CrossRefGoogle ScholarPubMed
Borson, S., Scanlan, J., Brush, M., Vitaliano, P. and Dokmak, A. (2000). The mini-cog: a cognitive “vital signs” measure for dementia screening in multi-lingual elderly. International Journal of Geriatric Psychiatry, 15, 1021–1027.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
Bynum, J. P. W., Rabins, P. V., Weller, W., Neifeild, M., Anderson, G. F. and Wu, A. W. (2004). The relationship between a dementia diagnosis, chronic illness, Medicare expenditures, and hospital use. Journal of the American Geriatrics Society, 52, 187–194.CrossRefGoogle ScholarPubMed
Callahan, C. M., Hendrie, H. C. and Tierney, W. M. (1995). Documentation and evaluation of cognitive impairment in elderly primary care patients. Annals of Internal Medicine, 122, 422–429.CrossRefGoogle ScholarPubMed
Cherry, D. L., Vickrey, B. G., Schwankovsky, L., Heck, E., Plauché, M. and Yep, R. (2004). Interventions to improve quality of care: the Kaiser Permanente–Alzheimer's Association Dementia Care Project. American Journal of Managed Care, 10, 553–560.Google ScholarPubMed
Chodosh, J. et al. (2006). A quality of care intervention for dementia: impact on provider knowledge, attitudes, and perceptions of dementia care quality. Journal of the American Geriatrics Society, 54, 311–317.CrossRefGoogle Scholar
Cummings, J. L. et al. (2002a). Guidelines for managing Alzheimer's disease. Part 1: assessment. American Family Physician, 65, 2263–2272.Google Scholar
Cummings, J. L. et al. (2002b). Guidelines for managing Alzheimer's disease. Part 2: treatment. American Family Physician, 65, 2525–2534.Google Scholar
Evans, D. A. et al. (1989). Prevalence of Alzheimer's disease in a community population of older persons. JAMA, 262, 2551–2556.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Hinton, L., Franz, C. E., Reddy, G., Flores, Y., Kravitz, R. L. and Barker, J. C. (2007). Practice constraints, behavioral problems, and dementia care: primary care physicians' perspectives. Journal of General Internal Medicine, 22, 1487–1492.CrossRefGoogle ScholarPubMed
Mittelman, M. S., Ferris, S. H., Shulman, E., Steinbers, G. and Levin, B. (1996). A family intervention to delay nursing home placement of patients with Alzheimer disease. JAMA, 276, 1725–1731.CrossRefGoogle ScholarPubMed
Qaseem, A. et al. (2008). Current pharmacologic treatment of dementia: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Annals of Internal Medicine, 148, 370–378, 379–397.CrossRefGoogle ScholarPubMed
Schulz, R., O'Brien, A. T., Bookwala, J. and Fleissner, K. (1995). Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. Gerontologist, 35, 771–791.CrossRefGoogle ScholarPubMed
Soumerai, S. B. and Avorn, J. (1990). Principles of educational outreach(‘academic detailing’) to improve clinical decision making. JAMA, 263, 549–556.CrossRefGoogle Scholar
Vickrey, B. G. et al. (2006). The effect of a disease management intervention on quality and outcomes of dementia care. Annals of Internal Medicine, 145, 713–726.CrossRefGoogle ScholarPubMed
Vitaliano, P. P., Zhang, J. and Scanlan, J. M. (2003). Is caregiving hazardous to one's physical health? A meta-analysis. Psychological Bulletin, 129, 946–972.CrossRefGoogle ScholarPubMed
Yesavage, J. A. et al. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 37–49.CrossRefGoogle Scholar