Llibre-Guerra Jorge J, Llerena Tania Zayas, Figueroa Zaily Martínez, Almirall-Sánchez Arianna, Rodríguez-Velasco Arianne, Santos Martínez Angel, Gutiérrez-Herrera Raúl F, Rodríguez-Salgado Ana M, Llibre-Rodríguez Juan J
Department of Neurology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA.
Dementia Research Unit, Medical University of Havana, Habana, Cuba.
Alzheimers Dement. 2025 May;21(5):e70283. doi: 10.1002/alz.70283.
Dementia disproportionately affects individuals in low- and middle-income countries (LMICs), yet diagnostic capabilities there are often inadequate. This study assesses the impact of a structured training program for primary care physicians (PCPs) in Cuba to improve early dementia detection.
We conducted a cluster-randomized trial involving 16 primary care clinics, randomizing them into intervention and control groups (CGs). The intervention group (IG) received comprehensive training on dementia diagnosis and management. The effectiveness was measured through changes in diagnosis rates and PCP diagnostic confidence over a 12-month period.
The IG demonstrated a significant improvement in PCP confidence and dementia diagnosis rates compared to baseline and the CG. Comparisons of clinic-based and community-based dementia prevalence highlighted the effectiveness of the intervention.
Structured training can significantly enhance the capabilities of PCPs in LMICs for early dementia detection. Ongoing training and integration into health systems are critical for sustaining these improvements.
This study developed and implemented a tailored training program for PCPs to specifically enhance their skills in dementia diagnosis. We used the 10/66 dementia protocol to benchmark and validate the effectiveness of the training program against community-based prevalence rates. In a cluster-randomized trial, we observed a significant post-training increase in dementia detection in primary care settings. Similar programs may address healthcare disparities by demonstrating the feasibility and impact of educational interventions in resource-constrained settings. We provide evidence-based recommendations for scaling similar training programs across other LMICs to improve dementia care globally.
痴呆症对低收入和中等收入国家（LMICs）的个人影响尤为严重，但这些国家的诊断能力往往不足。本研究评估了古巴针对初级保健医生（PCP）的结构化培训计划对改善早期痴呆症检测的影响。
我们进行了一项整群随机试验，涉及16家初级保健诊所，将它们随机分为干预组和对照组（CGs）。干预组（IG）接受了关于痴呆症诊断和管理的全面培训。通过12个月内诊断率和初级保健医生诊断信心的变化来衡量有效性。
与基线和对照组相比，干预组的初级保健医生信心和痴呆症诊断率有显著提高。基于诊所和基于社区的痴呆症患病率比较突出了干预的有效性。
结构化培训可以显著提高低收入和中等收入国家初级保健医生早期痴呆症检测的能力。持续培训并融入卫生系统对于维持这些改善至关重要。
本研究为初级保健医生制定并实施了量身定制的培训计划，以专门提高他们在痴呆症诊断方面的技能。我们使用10/66痴呆症协议，根据基于社区的患病率来衡量和验证培训计划的有效性。在一项整群随机试验中，我们观察到初级保健环境中培训后痴呆症检测有显著增加。类似的计划可以通过证明教育干预在资源有限环境中的可行性和影响来解决医疗保健差距问题。我们提供基于证据的建议，以在其他低收入和中等收入国家推广类似的培训计划，以改善全球的痴呆症护理。
