Parmar Jasneet, Dobbs Bonnie, McKay Rhianne, Kirwan Catherine, Cooper Tim, Marin Alexandra, Gupta Nancy
Associate Professor, in the Division of Care of the Elderly at the University of Alberta in Edmonton.
Professor and Director of Research, in the Division of Care of the Elderly at the University of Alberta in Edmonton.
Can Fam Physician. 2014 May;60(5):457-65.
To assess the current identification and management of patients with dementia in a primary care setting; to determine the accuracy of identification of dementia by primary care physicians; to examine reasons (triggers) for referral of patients with suspected dementia to the geriatric assessment team (GAT) from the primary care setting; and to compare indices of identification and management of dementia between the GAT and primary care network (PCN) physicians and between the GAT and community care (CC).
Retrospective chart review and comparisons, based on quality indicators of dementia care as specified in the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, were conducted from matching charts obtained from 3 groups of health care providers.
Semirural region in the province of Alberta involving a PCN, CC, and a GAT.
One hundred patients who had been assessed by the GAT randomly selected from among those diagnosed with dementia or mild cognitive impairment by the GAT.
Diagnosis of dementia and indications of high-quality dementia care listed in PCN, CC, and GAT charts.
Only 59% of the patients diagnosed with dementia by the GAT had a documented diagnosis of dementia in their PCN charts. None of the 12 patients diagnosed with mild cognitive impairment by the GAT had been diagnosed by the PCN. Memory decline was the most common reason for referral to the GAT. There were statistically significant differences between the PCN and the GAT on all quality indicators of dementia, with underuse of diagnostic and functional assessment tools and lack of attention to wandering, driving, medicolegal, and caregiver issues, and underuse of community supports in the PCN. There was higher congruence between CC and the GAT on assessment and care indices.
Dementia care remains a challenge in primary care. Within our primary care setting, there are opportunities for synergistic collaboration among the health care professionals from the PCN, CC, and the GAT. Currently they exist as individual entities in the system. An integrated model of care is required in order to build capacity to meet the needs of an aging population.
评估基层医疗环境中痴呆患者的当前识别与管理情况；确定基层医疗医生对痴呆的识别准确性；探究基层医疗环境中疑似痴呆患者被转诊至老年评估团队（GAT）的原因（触发因素）；并比较GAT与基层医疗网络（PCN）医生之间以及GAT与社区护理（CC）之间痴呆识别与管理的指标。
根据第三届加拿大痴呆诊断与治疗共识会议规定的痴呆护理质量指标，对从3组医疗服务提供者处获取的匹配病历进行回顾性图表审查和比较。
艾伯塔省的半农村地区，涉及一个PCN、CC和一个GAT。
从被GAT诊断为痴呆或轻度认知障碍的患者中随机选取100名接受过GAT评估的患者。
PCN、CC和GAT病历中痴呆的诊断以及高质量痴呆护理的指标。
在GAT诊断为痴呆的患者中，只有59%在其PCN病历中有痴呆的记录诊断。GAT诊断为轻度认知障碍的12名患者中，没有一人被PCN诊断出来。记忆力下降是转诊至GAT的最常见原因。在痴呆的所有质量指标上，PCN和GAT之间存在统计学显著差异，PCN存在诊断和功能评估工具使用不足、对游荡、驾驶、法医学和护理者问题缺乏关注以及社区支持使用不足的情况。CC和GAT在评估和护理指标上的一致性更高。
痴呆护理在基层医疗中仍然是一项挑战。在我们的基层医疗环境中，PCN、CC和GAT的医疗专业人员之间存在协同合作的机会。目前它们在系统中作为独立的实体存在。需要一个综合护理模式来建立满足老龄化人口需求的能力。
