JaKa Meghan M, Rossom Rebecca C, Borson Soo, O'Connor Patrick J, Zibley Laura J, von Sternberg Thomas L, Crain A Lauren, Ekstrom Heidi L, Crouse Bethany, Werner Ann M, Hanson Leah R
Center for Evaluation and Survey Research, HealthPartners Institute, Bloomington, 55425, United States.
HealthPartners Institute, Bloomington, 55425, United States.
Fam Pract. 2024 Oct 8;41(5):761-769. doi: 10.1093/fampra/cmae043.
As cognitive impairment (CI) prevalence rises and primary care screening becomes commonplace, it is critical to understand how to support clinicians. We describe clinician-reported barriers to diagnosing and managing care for patients with CI in a health system with standardized screening. We also explore whether barriers differ by clinician type-physician or advanced-practice clinician (APC).
Theory-informed surveys were administered to primary care clinicians in a large integrated health system. The survey assessed barriers, confidence in diagnosing CI and managing CI care, beliefs about the consequences of diagnosing CI, and usability of the electronic health record (EHR) to diagnose and manage CI care; it also included open-ended response items. Descriptive statistics and content analysis were used to describe perceived barriers. Differences by clinician type were compared using chi-square.
Of the 408 eligible clinicians, 249 started the survey and 247 completed the primary outcomes (61% response rate). Many said they were only a little or not at all confident in diagnosing (70%) and managing care for (60%) CI, with specific gaps in confidence in distinguishing types of dementia and having CI-related conversations with patients or family/care partners. APCs reported lower confidence than physicians. Other barriers were lack of time, low usability of EHR, and lack of family/care partner availability. These did not differ by clinician type. Open-ended responses suggest clinicians would like more support for CI care.
Low levels of confidence among other barriers suggest an urgent need to develop and implement effective multifaceted strategies to improve CI care.
随着认知障碍（CI）患病率上升以及初级保健筛查变得普遍，了解如何支持临床医生至关重要。我们描述了在一个进行标准化筛查的卫生系统中，临床医生报告的诊断和管理CI患者护理的障碍。我们还探讨了这些障碍是否因临床医生类型（医生或高级实践临床医生[APC]）而异。
对一个大型综合卫生系统中的初级保健临床医生进行了基于理论的调查。该调查评估了障碍、对诊断CI和管理CI护理的信心、对诊断CI后果的看法以及电子健康记录（EHR）用于诊断和管理CI护理的可用性；还包括开放式回答项目。使用描述性统计和内容分析来描述感知到的障碍。使用卡方检验比较临床医生类型之间的差异。
在408名符合条件的临床医生中，249人开始了调查，247人完成了主要结果（回复率61%）。许多人表示，他们对诊断（70%）和管理CI护理（60%）仅有一点信心或完全没有信心，在区分痴呆类型以及与患者或家庭/护理伙伴进行CI相关对话方面信心存在特定差距。APCs报告的信心低于医生。其他障碍包括时间不足、EHR可用性低以及家庭/护理伙伴无法提供帮助。这些在临床医生类型之间没有差异。开放式回答表明临床医生希望在CI护理方面获得更多支持。
除其他障碍外信心水平较低表明迫切需要制定和实施有效的多方面策略来改善CI护理。
