Department of Family and Community Medicine, Hamamatsu University School of Medicine, Shizuoka, Hamamatsu, Japan.
Omaezaki Family Medicine Center, Shizuoka, Omaezaki, Japan.
BMC Geriatr. 2021 Oct 11;21(1):540. doi: 10.1186/s12877-021-02457-7.
While dementia is a common problem in Japan and the US, primary care physicians' practices and perspectives about diagnosing dementia in these different healthcare systems are unknown.
Qualitative research was conducted in an ethnographic tradition using semi-structured interviews and thematic analysis in primary care settings across Japan and in the Midwest State of Michigan, US. Participants were a total of 48 primary care physicians, 24 each from Japan and the US participated. Both groups contained a mixture of geographic areas (rural/urban), gender, age, and years of experience as primary care physicians.
Participants in Japan and the US voiced similar practices for making the diagnosis of dementia and held similar views about the desired benefits of diagnosing dementia. Differences were found in attitudes about the appropriate timing of formally diagnosing dementia. Japanese physicians tended to make a formal diagnosis when problems that would benefit from long-term care services emerged for family members. US physicians were more proactive in diagnosing dementia in the early stages by screening for dementia in health check-ups and promoting advance directives when the patients were still capable of decision-making. Views about appropriate timing of diagnostic testing for dementia in the two systems reflect what medical or nursing care services physicians can use to support dementia patients and caregivers.
Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US. Testing to establish an early diagnosis of dementia by primary care physicians only partly relates to testing and treatment options available. Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US.
痴呆症在日本和美国是一个常见的问题，但初级保健医生在这两个不同医疗体系中诊断痴呆症的做法和观点尚不清楚。
在日本和美国的初级保健机构中，采用人种学传统进行定性研究，使用半结构化访谈和主题分析。参与者共有 48 名初级保健医生，日本和美国各有 24 名。两组参与者都包括不同地理区域（农村/城市）、性别、年龄和作为初级保健医生的经验年限。
日本和美国的参与者在做出痴呆症诊断的做法上表达了相似的观点，对诊断痴呆症的期望益处也有相似的看法。在正式诊断痴呆症的适当时机方面存在差异。日本医生倾向于在家庭成员出现需要长期护理服务的问题时正式做出诊断。美国医生则更积极地通过健康检查筛查痴呆症，并在患者仍有决策能力时促进预先指示，从而在早期阶段诊断痴呆症。这两个系统中关于痴呆症诊断测试适当时机的观点反映了医生可以使用哪些医疗或护理服务来支持痴呆症患者及其护理人员。
做出诊断的益处包括在日本激活长期护理服务的必要性，以及在美国进行早期干预和撰写预先指示的必要性。由初级保健医生进行的早期痴呆症诊断测试部分与可用的测试和治疗选择有关。做出诊断的益处包括在日本激活长期护理服务的必要性，以及在美国进行早期干预和撰写预先指示的必要性。
