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Exploring dementia management attitudes in primary care: a key informant survey to primary care physicians in 25 European countries

Published online by Cambridge University Press:  18 April 2017

Ferdinando Petrazzuoli Open the ORCID record for Ferdinando Petrazzuoli [Opens in a new window] ,
Shlomo Vinker ,
Tuomas H. Koskela ,
Thomas Frese ,
Nicola Buono ,
Jean Karl Soler ,
Jette Ahrensberg ,
Radost Asenova ,
Quintí Foguet Boreu  and
Gülsen Ceyhun Peker
...Show all authors
Ferdinando Petrazzuoli*
Affiliation:
Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
Shlomo Vinker
Affiliation:
Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Tuomas H. Koskela
Affiliation:
Omapihlaja Health Centre, University of Tampere, Tampere, Finland
Thomas Frese
Affiliation:
Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
Nicola Buono
Affiliation:
SNAMID (National Society of Medical Education in General Practice), Caserta, Italy
Jean Karl Soler
Affiliation:
Mediterranean Institute of Primary Care, Attard, Malta
Jette Ahrensberg
Affiliation:
Research Unit for General Practice, University of Aarhus, Aarhus, Denmark
Radost Asenova
Affiliation:
Department of General Practice, Medical University of Plovdiv, Plovdiv, Bulgaria
Quintí Foguet Boreu
Affiliation:
Institut Universitari d'Investigació en Atenció Primària- IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Catalonia, Spain
Gülsen Ceyhun Peker
Affiliation:
Ankara University School of Medicine, Department of Family Medicine, Ankara, Turkey
Claire Collins
Affiliation:
Irish College of General Practitioners, Dublin, Ireland
Miro Hanževački
Affiliation:
Director Health Care Center of Zagreb, Zagreb, Croatia
Kathryn Hoffmann
Affiliation:
Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
Claudia Iftode
Affiliation:
Timis Society of Family Medicine, Timisoara, Romania
Donata Kurpas
Affiliation:
Family Medicine Department, Wroclaw Medical University, Wroclaw, Poland
Jean Yves Le Reste
Affiliation:
Equipe D'accueil SPURBO. Department of General Practice, Université de Bretagne occidentale, Brest, France
Bjørn Lichtwarck
Affiliation:
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
Davorina Petek
Affiliation:
Department of Family medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Daniel Pinto
Affiliation:
Department of Family Medicine, NOVA Medical School, Lisbon, Portugal
Diego Schrans
Affiliation:
Department of Family Medicine and Primary Health Care Ghent University, Ghent, Belgium
Sven Streit
Affiliation:
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
Eugene Yee Hing Tang
Affiliation:
Institute of Health & Society, Newcastle University, Newcastle, UK
Athina Tatsioni
Affiliation:
Department of Internal Medicine, General Medicine, Faculty of Medicine, University of Ioannina School of Health Sciences, Ioannina, Greece
Péter Torzsa
Affiliation:
Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
Pemra C. Unalan
Affiliation:
Department of Family Medicine, Marmara University Medical Faculty, Istanbul, Turkey
Harm van Marwijk
Affiliation:
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
Hans Thulesius
Affiliation:
Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
*
Correspondence should be addressed to: Dr Ferdinando Petrazzuoli, MD, MSc, Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, CRC, Building 28, Floor 11, Jan Waldenströms gata, 35, Skåne University Hospital 205 02 Malmö, Sweden. Phone: +4640391363; Fax: +4640391370. Email: [email protected].
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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.

Keywords

Alzheimer's diseasedementiaprimary care
Type
Paper of the Month
Information
International Psychogeriatrics , Volume 29 , Issue 9 , September 2017 , pp. 1413 - 1423
Copyright
Copyright © International Psychogeriatric Association 2017 

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