Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.
School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
Front Public Health. 2022 Sep 23;10:943964. doi: 10.3389/fpubh.2022.943964. eCollection 2022.
Detection and management of mild cognitive impairment (MCI) in primary care has been recognized internationally as one of the strategies that can be employed to delay the development of dementia. However, little is known about what role primary care should play. This study aimed to develop a checklist of conditions necessary for successfully detecting and managing mild cognitive impairment in primary care in China.
This study employed the Delphi method to establish expert consensus on the conditions required for successfully detecting and managing MCI in primary care in China. Twenty-four experts who specialized in general practice, public health, neuropsychology, or community health service management rated the importance of pre-defined conditions (44 items measuring providers' preparedness, patient engagement, and system support in line with the Chronic Care Model). The degree of consensus among the experts was measured using four indicators: median ≥ 4, mean ≥3.5, Co-efficient of Variance < 0.25, and retention in the checklist required ≥ 80% agreement with a rating of important or essential. The checklist and descriptions of the conditions were revised according to the experts' feedback and then sent out for repeated consultations along with a summary of the results of the previous round of consultations. Consensus was achieved after the second round of consultations, which was completed by 22 of the experts.
The experts endorsed a checklist of 47 conditions required for successful detection and management of MCI in primary care in China. These conditions were categorized into four domains: prepared general practitioners (17 items), engaged patients (15 items), organizational efforts (11 items), and environmental support (4 items).
Successful detection and management of MCI in primary care in China requires a dedicated and competent workforce of general practitioners, as well as the engagement of patients and family caregivers. Adequate support from healthcare organizations, health system arrangements, and the broader society is needed to enable effective interactions between general practitioners and patients and efficient delivery of the services required to detect and manage MCI.
在初级保健中发现和管理轻度认知障碍（MCI）已被国际公认为可延缓痴呆发展的策略之一。然而，人们对初级保健应发挥的作用知之甚少。本研究旨在制定一份在中国初级保健中成功发现和管理轻度认知障碍所需条件的清单。
本研究采用德尔菲法，就中国初级保健中成功发现和管理 MCI 所需条件建立专家共识。24 名专门从事全科医学、公共卫生、神经心理学或社区卫生服务管理的专家对预定义条件（44 项衡量提供者准备情况、患者参与度和符合慢性病护理模式的系统支持的条件）的重要性进行了评分。采用四项指标衡量专家共识程度：中位数≥4、均值≥3.5、变异系数<0.25、清单中保留的条件≥80%同意重要或必要的评分。根据专家的反馈意见修订清单和条件说明，然后将其与前一轮咨询结果的摘要一起发送出去，供再次咨询。第二轮咨询完成后达成共识，有 22 名专家参与了第二轮咨询。
专家认可了一份在中国初级保健中成功发现和管理 MCI 所需的 47 项条件清单。这些条件分为四个领域：准备充分的全科医生（17 项）、参与的患者（15 项）、组织努力（11 项）和环境支持（4 项）。
在中国，要成功地在初级保健中发现和管理 MCI，需要有一支敬业且有能力的全科医生队伍，还需要患者及其家属的参与。需要有来自医疗保健组织、卫生系统安排和更广泛社会的充分支持，以实现全科医生与患者之间的有效互动，并提供发现和管理 MCI 所需的高效服务。
