Diagnosis and management of dementia in primary care: exploratory study.
OBJECTIVE
To assess the current identification and management of patients with dementia in a primary care setting; to determine the accuracy of identification of dementia by primary care physicians; to examine reasons (triggers) for referral of patients with suspected dementia to the geriatric assessment team (GAT) from the primary care setting; and to compare indices of identification and management of dementia between the GAT and primary care network (PCN) physicians and between the GAT and community care (CC).


METHODS
Retrospective chart review and comparisons, based on quality indicators of dementia care as specified in the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, were conducted from matching charts obtained from 3 groups of health care providers.


METHODS
Semirural region in the province of Alberta involving a PCN, CC, and a GAT.


METHODS
One hundred patients who had been assessed by the GAT randomly selected from among those diagnosed with dementia or mild cognitive impairment by the GAT.


METHODS
Diagnosis of dementia and indications of high-quality dementia care listed in PCN, CC, and GAT charts.


RESULTS
Only 59% of the patients diagnosed with dementia by the GAT had a documented diagnosis of dementia in their PCN charts. None of the 12 patients diagnosed with mild cognitive impairment by the GAT had been diagnosed by the PCN. Memory decline was the most common reason for referral to the GAT. There were statistically significant differences between the PCN and the GAT on all quality indicators of dementia, with underuse of diagnostic and functional assessment tools and lack of attention to wandering, driving, medicolegal, and caregiver issues, and underuse of community supports in the PCN. There was higher congruence between CC and the GAT on assessment and care indices.


CONCLUSIONS
Dementia care remains a challenge in primary care. Within our primary care setting, there are opportunities for synergistic collaboration among the health care professionals from the PCN, CC, and the GAT. Currently they exist as individual entities in the system. An integrated model of care is required in order to build capacity to meet the needs of an aging population.
Associate Professor, in the Division of Care of the Elderly at the University of Alberta in Edmonton. jasneet.parmar@albertahealthservices.ca.
Jasneet
J
Parmar
Professor and Director of Research, in the Division of Care of the Elderly at the University of Alberta in Edmonton.
Bonnie
B
Dobbs
Research Coordinator, in the Division of Care of the Elderly at the University of Alberta in Edmonton.
Rhianne
R
McKay
Student at the University of Alberta.
Catherine
C
Kirwan
Resident at the University of Alberta.
Tim
T
Cooper
Assistant Clinical Professor in the Division of Care of the Elderly at the University of Alberta.
Alexandra
A
Marin
International medical graduate and a volunteer in the Division of Care of the Elderly at the University of Alberta.
Nancy
N
Gupta
D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000628:therapy; D003704:Dementia / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies