title: How well are clinicians following dementia practice guidelines?
abstract: Although there are numerous clinical guidelines regarding the management of dementia, there have been few studies on their implementation in practice. Clinicians in six United States Department of Veterans Affairs medical centers (n = 200, 85% response rate) were surveyed regarding their use of practices recommended in the California Workgroup Guidelines for Alzheimer's Disease Management. The majority of providers (89% to 73%) reported that they routinely conducted neurological examinations, obtained histories from caregivers, discussed the diagnosis with the patient's family, discussed durable power of attorney, and made legally-required reports of drivers with dementia. Roughly two-thirds of providers said they routinely conducted cognitive screening examinations, screened for depression, reported elder abuse, and discussed care needs and decision-making issues with patients' families. Only half of all outpatient providers implemented caregiver support practices for at least half of their patients. Clinicians' choices of medications for cognition, mood, and behavior problems were broadly consistent with current practice guidelines. These results suggest possible priorities for quality improvement efforts. Further research is needed to clarify reasons for particular gaps between guidelines and practice and to identify specific targets for intervention.
authors.affiliation: VA Sierra-Pacific Mental Illness Research, Education and Clinical Center, Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA. crosen@stanford.edu
authors.forename: Craig S
authors.initials: CS
authors.lastname: Rosen
authors.forename: Helen C
authors.initials: HC
authors.lastname: Chow
authors.forename: Mark A
authors.initials: MA
authors.lastname: Greenbaum
authors.forename: John F
authors.initials: JF
authors.lastname: Finney
authors.forename: Rudolf H
authors.initials: RH
authors.lastname: Moos
authors.forename: Javaid I
authors.initials: JI
authors.lastname: Sheikh
authors.forename: Jerome A
authors.initials: JA
authors.lastname: Yesavage
mesh_terms: D016223:Advance Directives; D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000628:therapy; D001334:Automobile Driving / Q000331:legislation & jurisprudence; D001521:Behavior Therapy; D002140:California; D017028:Caregivers / Q000193:education; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy; D004552:Elder Abuse / Q000331:legislation & jurisprudence / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D017410:Practice Guidelines as Topic; D011368:Professional-Family Relations; D011785:Quality Assurance, Health Care