National patterns of dementia treatment among elderly ambulatory patients.
OBJECTIVE
To assess patterns of dementia/Alzheimer's disease (AD) management and to investigate predictive factors of cholinesterase inhibitor prescriptions.


METHODS
A cross-sectional study was conducted using a national survey among the elderly aged >60 from 2000 to 2002. Visit characteristics and cholinesterase inhibitor prescriptions associated with dementia/AD status were evaluated.


RESULTS
A total of 25,561 visit records were identified. Of the total visits, only 0.6% had dementia/AD records. Most of the dementia/AD visits were made by women (60.6%) and white patients (93.5%). Of the dementia/AD visits, about half (46.5%) were prescribed with one or more cholinesterase inhibitors. Donepezil was the most prevalent agent (68.0%) followed by rivastigmine (26.0%). Logistic regression analyses indicated that the physician's specialty was a strong predictor for cholinesterase inhibitor prescription; psychiatrists [odds ratio (OR)=5.5; p<0.01] and neurologists (OR=2.6; p<0.03) were more likely to prescribe cholinesterase inhibitor than other physicians. Other characteristics including race did not show significant association.


CONCLUSIONS
The study findings suggest that physicians who specialized in psychiatry and neurology predominantly provided ambulatory care services for dementia patients. More efforts should be given to detect and to treat dementia patients with cognitive-enhancing agents after the formal diagnosis in the ambulatory care setting.
Maneno
Mary K
MK
Center for Minority Health Services Research, Department of Clinical and Administrative Pharmacy Sciences, School of Pharmacy, Howard University, Washington, DC, USA.
Lee
Euni
E
Wutoh
Anthony K
AK
Zuckerman
Ilene H
IH
Jackson
Patrice
P
Lombardo
Fredric A
FA
Scott
Kenneth R
KR
Xue
Zhenyi
Z
D000368:Aged; D000553:Ambulatory Care; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy* / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
D002800:Cholinesterase Inhibitors