Pharmacist-Physician Interprofessional Collaboration to Promote Early Detection of Cognitive Impairment: Increasing Diagnosis Rate

Abstract

The increased pressure on primary care makes it important for other health care providers, such as community pharmacists, to collaborate with general practitioners in activities related to chronic disease care. Therefore, the objective of the present project was to develop a protocol of action that allows close pharmacist-physician collaboration to carry out a coordinated action for very early detection of cognitive impairment (CI).Methods: A comparative study to promote early detection of CI was conducted in 19 community pharmacies divided into two groups: one group with interprofessional collaboration (IPC) and one group without interprofessional collaboration (NonIPC). IPC was defined as an interactive procedure involving all pharmacists, general practitioners and neurologists. A total of 281 subjects with subjective memory complaints were recruited. Three tests were used in the community pharmacies to detect possible CI: Memory Impairment Screening, Short Portable Mental State Questionnaire, and Semantic Verbal Fluency. Individuals with at least one positive cognitive test compatible with CI, were referred to primary care, and when appropriate, to the neurology service. Finally, we evaluated the differences in clinical and diagnostic follow-up in both groups after six months.Results: The NonIPC study group included 38 subjects compatible with CI referred to primary care (27.54%). Ten were further referred to a neurology department (7.25%) and four of them (2.90%) obtained a confirmed clinical diagnosis of CI. In contrast, in the IPC group, 46 subjects (32.17%) showed results compatible with CI and were referred to primary care. Of these, 21 (14.68%) were subsequently referred to a neurology service, while the remaining 25 were followed up by primary care. Nineteen individuals out of those referred to a neurology service obtained a confirmed clinical diagnosis of CI (13.29%). The percentage of subjects in the NonIPC group referred to neurology and the percentage of subjects diagnosed with CI, was significantly lower in comparison to the IPC group (p-value = 0.0233; p-value = 0.0007, respectively).Conclusions: The creation of IPC teams involving community pharmacists, general practitioners, and neurologists allow for increased detection of patients with CI or undiagnosed dementia and facilitates their clinical follow-up. This opens the possibility of diagnosis in patients in the very early stages of dementia, which can have positive implications to improve the prognosis and delay the evolution of the disease.

CRIDECO Anticholinergic Load Scale: An Updated Anticholinergic Burden Scale. Comparison with the ACB Scale in Spanish Individuals with Subjective Memory Complaints

“…Subjects with positive results in at least one of these tests were classified as possible CI patients. With this protocol, the CI confirmation rate in neurology was 90% [50].…”

“…Patient recruitment ended with the onset of the SARS-CoV-2 pandemic in Spain. The protocol used was the same as in previous studies [50,51].…”

Pharmacists’ Knowledge of Factors Associated with Dementia: The A-to-Z Dementia Knowledge List

“…In this context, projects that aim to prevent dementia by disseminating information about the risks and protective factors for the disease and which promote the early detection of individuals with dementia are of particular importance [ 12 , 13 , 14 ]. To achieve that goal, many countries support the use of dementia prevention guidelines by training healthcare personnel.…”

“…Therefore, as shown in previous studies [ 12 ], community pharmacies are a suitable point for cognitive impairment (CI) screening and the interprofessional collaboration between pharmacists and physicians improves dementia diagnosis rates [ 14 ]. In the same line, community pharmacies represent a point of quality health information for many patients and so, continuous training of these professionals can directly impact the public health of the population.…”

Short cognitive screening in elderlies as a part of advanced pharmaceutical care in Slovak community pharmacies - The pilot study KOGNIMET-SK

“…We hypothesised that the short cognitive test realised under pharmaceutical care in community pharmacies could help identify risk groups of patients with potential cognitive decline and help to avoid further complications. Because of the increasing pressure on primary care, collaboration between community pharmacists and general practitioners is essential, especially in preventive programmes and regarding chronically ill patients (Ramos et al, 2021). The aim of this pilot study is to evaluate the implementation of a simple, easy-to-use cognitive screening test within the framework of pharmaceutical care of elderly patients (aged 60 years and over) in community pharmacies and to test the influence of MetS and its particular components on cognitive decline in this age group.…”