Investigating the impact of primary care payments on underdiagnosis in dementia: A difference‐in‐differences analysis

Mason, Anne; Liu, Dan; Kasteridis, Panagiotis; Goddard, Maria; Jacobs, Rowena; Wittenberg, Raphael; McGonigal, Gerard

doi:10.1002/gps.4897

Cited by 10 publications

(12 citation statements)

References 19 publications

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“…One of the MU's objective is the continuous training of primary care in various aspects of dementia, including diagnosis. Our results suggest that MU need to improve its training techniques, implementing effective schemes to increase awareness and diagnosis of dementia in primary care, as has been done elsewhere (59,60).…”

Section: The Number Of Patients Being Followed Upmentioning

confidence: 77%

Evaluating a Memory Clinic Using the RE-AIM Model. The Experience of the “Memory and Neuropsychiatry Clinic” in Hospital Del Salvador, Chile

et al. 2021

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The development of healthcare services for dementia is key to improving access to care and post-diagnostic support for people living with dementia. Memory Units have emerged as a new healthcare service composed of multidisciplinary teams with the goal of improving diagnosis and/or management of dementia patients. The main objective of this study was to describe and evaluate the Reach and Effectiveness of a Memory Unit in a public hospital in Chile, using the RE-AIM model, a multi-component model that allows for the evaluation of the implementation of ongoing healthcare programs. Regarding “R” (Reach): from March 2018 up to June 2019, a total of 510 patients were referred and assessed. Most patients came from primary care (51.9%) and from outpatient services at the Hospital Salvador (39.2%), particularly from the Neurology (63.3%) and Psychiatry (16.0%) departments. We estimated that our Memory Unit assessed 5.39% of all of the dementia patients living in the area of referral. With respect to “E” (Effectiveness): 419 patients are still being followed up at the Memory Unit. Ninety-one patients (18%) were discharged. Of these, 55 (66%) were referred to primary healthcare, 28 (31%) to other outpatient services, 9 (10%) to a specialized mental healthcare center, and 9 (10%) to a daycare center. Due to the short period of time that the Memory Unit has been operating, no other RE-AIM dimensions could be evaluated at this juncture. To our knowledge, this is the first implementation study of a Memory Unit in Latin America, and the first using the RE-AIM model. Although cultural differences worldwide might play a role in the lack of international guidelines, the publication of the experience of the first year of this unit in Chile could inform new countries about this process. Ongoing challenges include continuing to collect data to complement the RE-AIM evaluation and developing a protocol that can be adopted elsewhere in Chile and Latin America. Further studies are needed to assess the benefits of a Memory Unit in comparison to regular care and to develop a model that assures continuity and coordination of care for people with dementia.

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Section: The Number Of Patients Being Followed Upmentioning

confidence: 77%

Evaluating a Memory Clinic Using the RE-AIM Model. The Experience of the “Memory and Neuropsychiatry Clinic” in Hospital Del Salvador, Chile

et al. 2021

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“…37 Not diagnosing dementia or detecting dementia in its later stage is raised in the literature. 8,[10][11][12] It can be due to various Notes: Data are n (%). a χ 2 test.…”

Section: Discussionmentioning

confidence: 99%

“…The propensity to perform such an assessment depends on financial incentives for family doctors. 12 The diagnosed type of dementia is another factor that can influence the treatment with cognitive enhancers. In AD, ChE-Is and memantine are recommended.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7] In many countries, there is still the problem of late detection of dementia and too little appropriate therapy implementation. [8][9][10][11][12] Although no systematic screening for dementia in the general population is recommended, 13 it is emphasized, that assessing cognitive performance ought to be the inherent part of a comprehensive geriatric assessment. 14 Some studies support the diagnosis of dementia in very elderly patients with multiple comorbidities, as influencing their prognosis and quality of life.…”

Section: Introductionmentioning

confidence: 99%

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<p>Dementia Diagnoses and Treatment in Geriatric Ward Patients: A Cross-Sectional Study in Poland</p>

Wojszel

2020

CIA

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“…Political measures involving e.g. monetary incentives appeared to have been effective in closing the gap between recorded and expected prevalence of dementia in primary care [44–46]. Since there are no signs of significant progress in dementia therapy in the foreseeable future, we suggest that GP training should combine positive attitudes towards dementia care with a special focus on a holistic advance care planning approach to care for patients with dementia.…”

Section: Discussionmentioning

confidence: 99%

General practitioners’ attitudes towards early diagnosis of dementia: a cross-sectional survey

et al. 2019

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Background Dementia is often underdiagnosed in general practice, which may be based on general practitioners’ (GPs’) knowledge and emotional factors as well as external problems. This study aimed to describe GPs’ attitudes toward early diagnosis of dementia. Methods Cross-sectional postal survey in Switzerland in 2017. Members of the Swiss Association of General Practitioners ( N = 4460) were asked to participate in the survey. The questionnaire assessed attitudes, enablers and barriers to early dementia diagnosis and post-diagnostic intervention strategies. Exploratory factor analysis and linear regression were used. Results The survey response rate was 21%. 85% of GPs agreed with enablers of early dementia recognition (e.g. “Plan for the future, organize support and care”, “Minimize the strain and insecurity of patients and their informal family caregivers”). On the other hand, 15% of respondents perceived barriers towards early dementia recognition (e.g. “Time constraints in carrying out the necessary procedures to diagnose dementia”). GPs who were more likely to agree with barriers would less often counsel family members (β = − 0.05, 95% CI = − 0.09 - -0.02) or test fitness to drive (β = − 0.05, 95% CI = − 0.09 - -0.02), and more often choose a watchful waiting strategy (β = 0.05, 95% CI = 0.02–0.09). Conclusions The attitude of the majority of GPs is not characterized by diagnostic and therapeutic nihilism. However, negative attitudes were associated with sub-optimal management after the diagnosis. Thus, health systems are required to critically examine the use of available resources allowing GPs to look after patients and their relatives in a holistic way. Electronic supplementary material The online version of this article (10.1186/s12875-019-0956-1) contains supplementary material, which is available to authorized users.

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Investigating the impact of primary care payments on underdiagnosis in dementia: A difference‐in‐differences analysis

Cited by 10 publications

References 19 publications

Evaluating a Memory Clinic Using the RE-AIM Model. The Experience of the “Memory and Neuropsychiatry Clinic” in Hospital Del Salvador, Chile

Evaluating a Memory Clinic Using the RE-AIM Model. The Experience of the “Memory and Neuropsychiatry Clinic” in Hospital Del Salvador, Chile

<p>Dementia Diagnoses and Treatment in Geriatric Ward Patients: A Cross-Sectional Study in Poland</p>

General practitioners’ attitudes towards early diagnosis of dementia: a cross-sectional survey

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