title: Multisite qualitative study of primary care physicians' and midlevel providers' self-reported practices and perceptions about maintaining cognitive health.
abstract: BACKGROUND
  To facilitate national efforts to maintain cognitive health through public health practice, the Healthy Brain Initiative recommended examining diverse groups to identify stakeholder perspectives on cognitive health. In response, the Healthy Aging Research Network (HAN), funded by the Centers for Disease Control and Prevention (CDC), coordinated projects to document the perspectives of older adults, caregivers of people with dementia, and primary care providers (PCPs) on maintaining cognitive health. Our objective was to describe PCPs' perceptions and practices regarding cognitive health.
  
  
  METHODS
  HAN researchers conducted 10 focus groups and 3 interviews with physicians (N = 28) and advanced practice providers (N = 21) in Colorado, Texas, and North Carolina from June 2007 to November 2008. Data were transcribed and coded axially.
  
  
  RESULTS
  PCPs reported addressing cognitive health with patients only indirectly in the context of physical health or in response to observed functional changes and patient or family requests. Some providers felt evidence on the efficacy of preventive strategies for cognitive health was insufficient, but many reported suggesting activities such as games and social interaction when queried by patients. PCPs identified barriers to talking with patients about cognitive health such as lack of time and patient reactions to recommendations.
  
  
  CONCLUSIONS
  Communicating new evidence on cognitive health and engaging older adults in making lasting lifestyle changes recommended by PCPs and others may be practical ways in which public health practitioners can partner with PCPs to address cognitive health in health care settings.
authors.affiliation: Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, 2401 S 31st St, MS-09-C633A, Temple, TX 76508, USA. ahochhalter@sw.org
authors.forename: Angela K
authors.initials: AK
authors.lastname: Hochhalter
authors.forename: Lucinda L
authors.initials: LL
authors.lastname: Bryant
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hunter
authors.forename: Rui
authors.initials: R
authors.lastname: Liu
authors.forename: Daniela B
authors.initials: DB
authors.lastname: Friedman
authors.forename: Anna E
authors.initials: AE
authors.lastname: Price
authors.forename: Joseph
authors.initials: J
authors.lastname: Sharkey
authors.forename: Swarna
authors.initials: S
authors.lastname: Reddy
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Caprio
authors.forename: Sindy
authors.initials: S
authors.lastname: McCrystle
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers; D003072:Cognition Disorders / Q000517:prevention & control; D003120:Colorado; D003704:Dementia / Q000628:therapy*; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010287:Parent-Child Relations; D010821:Physicians, Family / Q000523:psychology* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods*; D057566:Self Report; D013781:Texas