Abstract:BackgroundPrimary care-based memory clinics (PCMCs) have been established in several jurisdictions to improve the care for persons with Alzheimer’s disease and related dementias. We sought to identify key quality indicators (QIs), quality improvement mechanisms, and potential barriers and facilitators to the establishment of a quality assurance framework for PCMCs.MethodsWe employed a Delphi approach to obtain consensus from PCMC clinicians and specialist physicians on QIs and quality improvement mechanisms. T… Show more
“…( 26 , 27 , 29 ) We have previously shown that close integration of specialists within PCMCs can serve as a means to increase capacity, and this could apply to training related to a standardized physical examination. ( 22 , 30 ) Furthermore, the lack of agreement among respondents regarding which providers are best suited for specific assessment components mirrors our previous results regarding the integration of PCMCs within the broader health system, and the related need for clarity on mutually understood roles among all clinicians across the system. ( 22 )…”
Section: Discussionsupporting
confidence: 74%
“…( 22 , 30 ) Furthermore, the lack of agreement among respondents regarding which providers are best suited for specific assessment components mirrors our previous results regarding the integration of PCMCs within the broader health system, and the related need for clarity on mutually understood roles among all clinicians across the system. ( 22 )…”
Section: Discussionsupporting
confidence: 74%
“…In the resource-constrained primary care context, it is important to identify which, if any, physical examination maneuvers are required to inform the differential diagnosis or management decisions such as referral to a specialist for further assessment. ( 21 ) In the context of a larger study to obtain consensus among PCMC clinicians and specialists on a Quality Assurance framework for dementia care, ( 22 ) we sought to identify which physical examination maneuvers are essential to ADRD diagnosis and management. We also explored perceptions about which clinicians are best suited to perform specific components of the physical examination.…”
BackgroundPrimary care-based memory clinics were established to meet the needs of persons with memory concerns. We aimed to identify: 1) physical examination maneuvers required to assess persons with possible dementia in specialist-supported primary care-based memory clinics, and 2) the best-suited clinicians to perform these maneuvers in this setting.MethodsWe distributed in-person and online surveys of clinicians in a network of 67 primary care-based memory clinics in Ontario, Canada.Results90 surveys were completed for an overall response rate of 66.7%. Assessments of vital signs, gait, and for features of Parkinsonism were identified as essential by most respondents. There was little consensus on which clinician should be responsible for specific physical examination maneuvers.ConclusionsWhile we identified specific physical examination maneuvers deemed by providers to be both necessary and feasible to perform in the context of primary care-based memory clinics, further research is needed to clarify interprofessional roles related to the examination.
“…( 26 , 27 , 29 ) We have previously shown that close integration of specialists within PCMCs can serve as a means to increase capacity, and this could apply to training related to a standardized physical examination. ( 22 , 30 ) Furthermore, the lack of agreement among respondents regarding which providers are best suited for specific assessment components mirrors our previous results regarding the integration of PCMCs within the broader health system, and the related need for clarity on mutually understood roles among all clinicians across the system. ( 22 )…”
Section: Discussionsupporting
confidence: 74%
“…( 22 , 30 ) Furthermore, the lack of agreement among respondents regarding which providers are best suited for specific assessment components mirrors our previous results regarding the integration of PCMCs within the broader health system, and the related need for clarity on mutually understood roles among all clinicians across the system. ( 22 )…”
Section: Discussionsupporting
confidence: 74%
“…In the resource-constrained primary care context, it is important to identify which, if any, physical examination maneuvers are required to inform the differential diagnosis or management decisions such as referral to a specialist for further assessment. ( 21 ) In the context of a larger study to obtain consensus among PCMC clinicians and specialists on a Quality Assurance framework for dementia care, ( 22 ) we sought to identify which physical examination maneuvers are essential to ADRD diagnosis and management. We also explored perceptions about which clinicians are best suited to perform specific components of the physical examination.…”
BackgroundPrimary care-based memory clinics were established to meet the needs of persons with memory concerns. We aimed to identify: 1) physical examination maneuvers required to assess persons with possible dementia in specialist-supported primary care-based memory clinics, and 2) the best-suited clinicians to perform these maneuvers in this setting.MethodsWe distributed in-person and online surveys of clinicians in a network of 67 primary care-based memory clinics in Ontario, Canada.Results90 surveys were completed for an overall response rate of 66.7%. Assessments of vital signs, gait, and for features of Parkinsonism were identified as essential by most respondents. There was little consensus on which clinician should be responsible for specific physical examination maneuvers.ConclusionsWhile we identified specific physical examination maneuvers deemed by providers to be both necessary and feasible to perform in the context of primary care-based memory clinics, further research is needed to clarify interprofessional roles related to the examination.
“…There is, however, significant existing evidence that high-volume PCPs achieve their high volume through briefer appointments [9][10][11]. Our use of health administrative data limited the scope of primary care quality indicators for people with dementia we could assess; the relation of high-volume care and quality indicators such as patient or caregiver satisfaction, frequent reassessment of cognitive status and provision of caregiver support [20,48,49] should be studied in subsequent work. Also, our measure of influenza vaccination has only moderate sensitivity and specificity.…”
Background
Some jurisdictions restrict primary care physicians’ daily patient volume to safeguard quality of care for complex patients. Our objective was to determine whether people with dementia receive lower-quality care if their primary care physician sees many patients daily.
Methods
Population-based retrospective cohort study using health administrative data from 100,256 community-living adults with dementia aged 66 years or older, and the 8,368 primary care physicians who cared for them in Ontario, Canada. Multivariable Poisson GEE regression models tested whether physicians’ daily patient volume was associated with the adjusted likelihood of people with dementia receiving vaccinations, prescriptions for cholinesterase inhibitors, benzodiazepines, and antipsychotics from their primary care physician.
Results
People with dementia whose primary care physicians saw ≥ 30 patients daily were 32% (95% CI: 23% to 41%, p < 0.0001) and 25% (95% CI: 17% to 33%, p < 0.0001) more likely to be prescribed benzodiazepines and antipsychotic medications, respectively, than patients of primary care physicians who saw < 20 patients daily. Patients were 3% (95% CI: 0.4% to 6%, p = 0.02) less likely to receive influenza vaccination and 8% (95% CI: 4% to 13%, p = 0.0001) more likely to be prescribed cholinesterase inhibitors if their primary care physician saw ≥ 30 versus < 20 patients daily.
Conclusions
People with dementia were more likely to receive both potentially harmful and potentially beneficial medications, and slightly less likely to be vaccinated by high-volume primary care physicians.
“…Hategan et al (2) examine the associations between emergency department use and homelessness in the geriatric population. Clinical gaps in the in-patient care of geriatric in-patients with heart failure, as perceived by the patient’s caregivers, are systematically examined by Azad et al (3) A careful methodological examination of the Team Standardized Assessment of Clinical Encounter Report (Team StACER) is performed by Dr. Camilla Wong et al ., (4) and Heckman et al (5) examine the key quality assurance components involved in providing good community dementia care.…”
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