Wilcock Jane, Iliffe Steve, Turner Stephen, Bryans Michelle, O'Carroll Ronan, Keady John, Levin Enid, Downs Murna
Research Department of Primary Care & Population Health, RFUCLMS, London, UK.
Aging Ment Health. 2009 Mar;13(2):155-61. doi: 10.1080/13607860802636206.
Dementia is said to be under-recognized and sub-optimally managed in primary care, but there is little information about actual processes of diagnosis and clinical care.
To determine general practitioners' concordance with clinical guidelines on the diagnosis and management of patients with dementia.
Unblinded, cluster randomized pre-test-post-test controlled trial involving 35 practices in the UK.
Patients with a diagnosis of probable or confirmed dementia were identified in practices, and permission sought from the older person and/or their carer to study the medical records of these patients. Medical records were reviewed using a data extraction tool designed for the study and based on published guidelines, and unweighted scores for diagnostic concordance and management concordance were calculated.
We reviewed 450 records of patients aged 75 and over with a diagnosis of dementia and found that: only 4% of cases were identified first in secondary care; two-thirds of those identified in primary care were referred immediately; about one-third identified had informant history and blood tests documented at the Index consultation and one-fifth underwent cognitive function testing.
The records analysed in this study came from a period before the Quality Outcomes Framework and show that the documentation in primary care of the diagnostic process in dementia syndromes is good, although there were significant gaps, particularly around depression case-finding. Information about management processes were less evident in the records.
据说痴呆症在初级保健中未得到充分认识且管理欠佳，但关于实际诊断过程和临床护理的信息却很少。
确定全科医生在痴呆症患者诊断和管理方面与临床指南的一致性。
涉及英国35家医疗机构的非盲、整群随机前后测对照试验。
在各医疗机构中识别出诊断为可能或确诊痴呆症的患者，并征得老年人和/或其护理人员的同意，以研究这些患者的病历。使用为该研究设计并基于已发表指南的数据提取工具对病历进行审查，并计算诊断一致性和管理一致性的未加权分数。
我们审查了450份75岁及以上诊断为痴呆症患者的病历，发现：只有4%的病例首先在二级护理中被识别；在初级护理中被识别的患者中有三分之二立即被转诊；约三分之一被识别的患者在初次会诊时有 informant history 和血液检查记录，五分之一接受了认知功能测试。
本研究分析的病历来自质量结果框架出台之前的时期，结果表明，痴呆症综合征诊断过程在初级护理中的记录良好，尽管存在显著差距，尤其是在抑郁症病例发现方面。病历中关于管理过程的信息不太明显。
