Lombardi Gemma, Chipi Elena, Arenella Domenico, Fiorani Ambra, Frisoni Giovanni Battista, Linarello Simona, Montanucci Chiara, Muscio Cristina, Pacifico Irene, Pelizzari Silvia, Perani Daniela, Piras Fabrizio, Rozzini Luca, Sorbi Sandro, Spalletta Gianfranco, Tagliavini Fabrizio, Tiraboschi Pietro, Parnetti Lucilla, Filippini Graziella
IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.
Centre for Memory Disturbances, Section of Neurology, Lab of Clinical Neurochemistry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
Front Psychiatry. 2022 Nov 24;13:1050583. doi: 10.3389/fpsyt.2022.1050583. eCollection 2022.
Timely detection of cognitive decline in primary care is essential to promote an appropriate care pathway and enhance the benefits of interventions. We present the results of a study aimed to evaluate the effectiveness of an educational intervention addressed to Italian family physicians (FPs) to improve timely detection and management of cognitive decline.
We conducted a pre-post study in six Italian health authorities (HAs) involving 254 FPs and 3,736 patients. We measured process and outcome indicators before the intervention (1 January 2014 to 31 December 2016) and after the intervention (1 January 2018 to 31 December 2019). One interactive face-to-face session workshop was delivered by local cognitive disorders and dementia specialists and FP advisors at each HA, in the period September 2017-December 2017. The session focused on key messages of the local Diagnostic and Therapeutic Care Pathway (DTCP) or regional guidelines: (a) the role of the FP for a timely suspicion of cognitive decline is fundamental; (b) when cognitive decline is suspected, the role of the FP is active in the diagnostic work-up; (c) FP's knowledge on pharmacological and non-pharmacological interventions is essential to improve the management of patients with cognitive decline.
An overall improvement in diagnostic procedures and management of patients with cognitive decline by FPs after the intervention was observed. The number of visits per year performed by FPs increased, and the time interval between the first FP consultation and the diagnosis was optimized. Neuroleptic use significantly decreased, whereas the use of benzodiazepines remained steadily high. Non-pharmacological interventions, or use of support services, were underrepresented even in the post-intervention. Differences among the participating HAs were identified and discussed.
Results from this study suggest the success of the educational intervention addressed to FPs in improving early detection and management of cognitive decline, highlighting the importance to continue medical education in this field. At the same time, further initiatives of care pathway dissemination and implementation should promote strategies to enhance interactions between primary and secondary care optimizing the collaboration between FPs and specialists.
在初级保健中及时发现认知功能衰退对于促进恰当的护理途径及增强干预效果至关重要。我们呈现了一项研究的结果，该研究旨在评估针对意大利家庭医生开展的一项教育干预措施在改善认知功能衰退的及时发现与管理方面的有效性。
我们在意大利的六个卫生当局（HA）开展了一项前后对照研究，涉及254名家庭医生和3736名患者。我们在干预前（2014年1月1日至2016年12月31日）和干预后（2018年1月1日至2019年12月31日）测量了过程指标和结果指标。2017年9月至12月期间，由当地认知障碍和痴呆症专家以及每个卫生当局的家庭医生顾问举办了一次面对面互动研讨会。该研讨会聚焦于当地诊断与治疗护理途径（DTCP）或地区指南的关键信息：（a）家庭医生及时怀疑认知功能衰退的作用至关重要；（b）当怀疑认知功能衰退时，家庭医生在诊断检查中发挥积极作用；（c）家庭医生关于药物和非药物干预的知识对于改善认知功能衰退患者的管理至关重要。
观察到干预后家庭医生在认知功能衰退患者的诊断程序和管理方面总体有所改善。家庭医生每年进行的就诊次数增加，首次家庭医生咨询与诊断之间的时间间隔得到优化。抗精神病药物的使用显著减少，而苯二氮䓬类药物的使用仍持续居高。即使在干预后，非药物干预或支持服务的使用情况也未得到充分体现。确定并讨论了参与研究的各卫生当局之间的差异。
本研究结果表明，针对家庭医生的教育干预措施在改善认知功能衰退的早期发现与管理方面取得了成功，凸显了在该领域持续开展医学教育的重要性。与此同时，护理途径传播和实施的进一步举措应推动各项策略，以加强初级保健与二级保健之间的互动，优化家庭医生与专科医生之间的协作。
