Wilcock Jane, Jain Priya, Griffin Mark, Thuné-Boyle Ingela, Lefford Frances, Rapp David, Iliffe Steve
a Research Department of Primary Care and Population Health , University College London , London , United Kingdom.
Aging Ment Health. 2016;20(4):362-9. doi: 10.1080/13607863.2015.1011082. Epub 2015 Feb 23.
Improving quality of care for people with dementia is a high priority. Considerable resources have been invested in financial incentives, guideline development, public awareness and educational programmes to promote earlier diagnosis and better management.
Evaluating family physicians' concordance with guidelines on diagnosis and management of people with dementia, from first documentation of symptoms to formal diagnosis.
Analysis of medical records of 136 people with dementia recruited by 19 family practices in NW London and surrounding counties.
Practices invited 763 people with dementia to participate, 167 (22%) agreed. Complete records were available for 136 (18%). The majority of records included reference to recommended blood tests, informant history and caregiver concerns. Presence or absence of symptoms of depression, psychosis, other behavioural and psychological symptoms of dementia, and cognitive function tests were documented in 30%-40% of records. Documentation of discussions about signs and symptoms of dementia, treatment options, care, support, financial, legal and advocacy advice were uncommon. Comparison of these findings from a similar study in 2000-2002 suggests improvements in concordance with blood tests, recording informant history, presence or absence of depression or psychosis symptoms. There was no difference in documenting cognitive function tests. Immediate referral to specialists was more common in the recent study.
Five years after UK dementia guidelines and immediately after the launch of the dementia strategy, family physicians appeared concordant with clinical guidelines for dementia diagnosis (other than cognitive function tests), and referred most patients immediately. However, records did not suggest systematic dementia management.
提高痴呆症患者的护理质量是一项高度优先事项。已投入大量资源用于经济激励、指南制定、公众意识和教育项目，以促进早期诊断和更好的管理。
评估家庭医生在痴呆症患者诊断和管理指南方面的一致性，从症状首次记录到正式诊断。
分析伦敦西北部和周边郡县19家家庭诊所招募的136名痴呆症患者的病历。
各诊所邀请了763名痴呆症患者参与，167名（22%）同意。136名（18%）患者有完整记录。大多数记录包括提及推荐的血液检查、 informant病史和护理人员关注的问题。3０%-4０%的记录中记录了是否存在抑郁、精神病、其他痴呆行为和心理症状以及认知功能测试。关于痴呆症体征和症状、治疗选择、护理、支持、财务、法律和宣传建议的讨论记录并不常见。与2000 - 2002年类似研究的这些结果相比，血液检查、记录 informant病史、抑郁或精神病症状的存在与否方面的一致性有所提高。在记录认知功能测试方面没有差异。在最近的研究中，立即转诊给专科医生更为常见。
英国痴呆症指南发布五年后以及痴呆症战略启动后，家庭医生似乎与痴呆症诊断临床指南一致（认知功能测试除外），并立即转诊了大多数患者。然而，记录并未显示有系统的痴呆症管理。
