The primary care physician and Alzheimer's disease: An international position paper

Abstract

This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer's disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a literature review and expert's opinions who met in Paris, France, on July 2009 during the International Association of Geriatrics and Gerontology (IAGG) World Congress. The PCP's intervention appears essential at many levels: detection of the onset of dementia, diagnostic management, treatment and follow-up. The key role of the PCP in the management of AD, as care providers and care planners, is consolidated by the family caregiver's confidence in their skills. In primary care practice the first step is to identify dementia. The group proposes a "case finding" strategy, in target situations in which dementia should be detected to allow, secondarily, a diagnosis of AD, in certain cases. We propose that the PCP identifies 'typical' cases. In typical cases, among older subjects, the diagnosis of "probable AD" can be done by the PCP and then confirm by the specialist. While under-diagnosis of AD exists, so does under-disclosure. Disclosure to patient and family should be done by both specialist and PCP. Then, the PCP has a central role in management of the disease with the general objectives to detect, prevent and treat, when possible, the complications of the disease (falls, malnutrition, behavioural and psychological symptoms of dementia). The PCP needs to give basic information to the caregiver on respite care and home support services in order to prevent crisis situations such as unplanned institutionalisation and "emergency" hospital admission. Finally, therapeutic research must be integrated in the daily practice of PCP. It is a matter of patients' right to benefit from access to innovation and clinical research whatever his age or diseases, while of course fully respecting the rules and protective measures that are in force.

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

“…29 Primary care services are the first point of contact and main healthcare service for people with dementia. [30][31][32] It has been shown that the quality of annual reviews done in primary care for dementia is suboptimal and, despite a high prevalence of vascular diseases, over one-quarter of individuals diagnosed with dementia are prescribed antipsychotic medications that are known to increase the risk of cerebrovascular accidents and mortality. 33 In the current study, the quality of care for vascular conditions and risk factors received by…”

Quality of care provided to people with dementia: utilisation and quality of the annual dementia review in general practice

“…8 Primary care services are the first point of contact and main healthcare service for people with dementia. [9][10][11] In 2006, the annual dementia review was first introduced as a quality indicator to the UK Quality and Outcomes Framework (QOF) pay-for-performance guidelines for general practice. 12 This review, along with an indicator relating to a register of all people diagnosed with dementia in each practice, requires that there is a record of an annual dementia review from the previous 15 months for all patients on the dementia register.…”

The role of primary care in the recognition of and response to dementia

“…For these reasons careful thought ought to be given to the development of more efficient and innovative care provision and pathways that will be able to amalgamate all three strategies, to a lesser or greater degree. Only in this way will primary care practitioners be able to achieve high standards of care for their patients with dementia (29).…”