Primary care providers' views of challenges and rewards of dementia care relative to other conditions.
OBJECTIVE
To compare primary care providers' (PCPs') perceptions about dementia and its care within their healthcare organization with perceptions of other common chronic conditions and to explore factors associated with differences.


METHODS
Cross-sectional survey.


METHODS
Three California healthcare organizations.


METHODS
One hundred sixty-four PCPs.


METHODS
PCPs' views about primary care for dementia were analyzed and compared with views about care for heart disease, diabetes mellitus, and selected other conditions. Differences in views about conditions according to PCP type (internists, family physicians) were assessed. Multivariate analysis examined relationships between provider and practice characteristics and views about dementia care.


RESULTS
More PCPs strongly agreed that older patients with dementia are difficult to manage (23.8%) than for heart disease (5.0%) or diabetes mellitus (6.3%); PCPs can improve quality of life for heart disease (58.9%) and diabetes mellitus (61.6%) than for dementia (30.9%); older patients should be routinely screened for heart disease (63.8%) and diabetes mellitus (67.7%) than dementia (55.5%); and their organizations have expertise/referral resources to manage diabetes mellitus (49.4%) and heart disease (51.8%) than dementia (21.1%). More PCPs reported almost effortless organizational care coordination for heart disease (13.0%) or diabetes mellitus (13.7%) than for dementia (5.6%), and a great deal or many opportunities for improvement in their ability to manage dementia (50.6%) than incontinence, depression, or hypertension (7.4-34.0%; all P<.05). Internists' views regarding dementia care were less optimistic than those of family physicians, but PCP type was unrelated to views on diabetes mellitus or heart disease.


CONCLUSIONS
Improving primary care management of dementia should directly address PCP concerns about expertise and referral resources, difficulty of care provision, and PCP views about prospects for patient improvement.
Harris
Dorothy P
DP
Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA.
Chodosh
Joshua
J
Geriatric Research Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Sepulveda, CA.|Health Services Research and Development Service (HSR&D) Sepulveda Center of Excellence, VA Greater Los Angeles Healthcare System, Sepulveda, CA.|Department of Medicine, Division of Geriatrics, UCLA David Geffen School of Medicine, Los Angeles, CA.
Vassar
Stefanie D
SD
Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA.|Department of Neurology, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
Vickrey
Barbara G
BG
Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA.|Department of Neurology, VA Greater Los Angeles Healthcare System, Los Angeles, CA.|Health Services Research and Development Service (HSR&D) Sepulveda Center of Excellence, VA Greater Los Angeles Healthcare System, Sepulveda, CA.
Shapiro
Martin F
MF
Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA.|Department of Health Services, UCLA David Geffen School of Medicine, Los Angeles, CA.
D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003704:Dementia / Q000628:therapy*; D005194:Family Practice; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007388:Internal Medicine; D008297:Male; D011320:Primary Health Care