title: [Quality of registration of dementia diagnosis in primary care: The situation in Spain in 2002-2011].
abstract: OBJECTIVE
  To ascertain the diagnosis associated with specific treatment for dementia in the Primary Care Electronic Clinical Record (PC-ECR) and to analyse the factors associated with the quality of registration.
  
  
  METHODS
  Descriptive study of patients taking cholinesterase inhibitors or memantine registered in Database for pharmacoepidemiological research in PC (BIFAP) 2011: 24,575 patients between 2002 and 2011. Diagnoses associated with first prescription of these drugs were grouped into 5 categories: "dementia", "memory impairment", "dementia-related diseases", "intercurrent processes" and "convenience codes". We calculated the prevalence of each category by age and sex for each study year (95%CI) and analysed the associations and trend for 2002-2011 using difference in proportions in independent samples and binary logistic regression.
  
  
  RESULTS
  A code of "dementia" was associated with first prescription in 56.5% (95%CI: 55.8-57.1) of patients. It was higher in women [OR1.09 (95%CI: 1.03-1.15)] and with increasing follow-up time [OR1.07 (95%CI: 1.06-1.08) for each year of follow-up]. "Convenience codes" [16.3% (95%CI: 15.8-16.7)] were coded more frequently in women and in those ≥80 years; "Memory impairment" [12.4% (95%CI: 12.0-12.8)], "related diseases" [4.6% (95%CI: 4.4-4.8)] and "intercurrent processes" [10.3% (95%CI: 9.9-10.6)] were used more in men and in persons <80 years. Between 2002 and 2011 improved the use of "convenience codes".
  
  
  CONCLUSIONS
  Almost half of the patients taking cholinesterase inhibitors or memantine do not have a diagnosis of dementia registered in their PC-ECR. Registration improves with increasing time of follow-up. Improvements are needed in the PC-ECR, adequate care coordination, and proactive approach to increase the quality of dementia registration.
authors.affiliation: Centro de Salud Pedro Laín Entralgo, DA Oeste, Servicio Madrileño de Salud, Alcorcón, Madrid, España. Electronic address: canto-hoyos@gmail.com.
authors.forename: María del Canto
authors.initials: Mdel C
authors.lastname: de Hoyos-Alonso
authors.affiliation: Programa BIFAP, División de Farmacoepidemiología y Farmacovigilancia, Agencia Española del Medicamento y Productos Sanitarios, Madrid, España.
authors.forename: Julio
authors.initials: J
authors.lastname: Bonis
authors.affiliation: Programa BIFAP, División de Farmacoepidemiología y Farmacovigilancia, Agencia Española del Medicamento y Productos Sanitarios, Madrid, España.
authors.forename: Verónica
authors.initials: V
authors.lastname: Bryant
authors.affiliation: Centro de Salud Dr. Castroviejo, DA Norte, Servicio Madrileño de Salud, Madrid, España; IdiPAZ, Instituto de Investigación La Paz, Madrid, España.
authors.forename: María Victoria
authors.initials: MV
authors.lastname: Castell Alcalá
authors.affiliation: IdiPAZ, Instituto de Investigación La Paz, Madrid, España; Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid (UAM), Madrid, España.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Otero Puime
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003704:Dementia / Q000175:diagnosis* / Q000188:drug therapy; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008559:Memantine / Q000627:therapeutic use; D008875:Middle Aged; D011320:Primary Health Care; D011786:Quality Control; D012042:Registries; D013030:Spain
chemical_list: D002800:Cholinesterase Inhibitors; D008559:Memantine
keywords: Anticolinesterásicos; Atención primaria; Calidad de registro; Cholinesterase inhibitors; Demencia; Dementia; Infradiagnóstico; Memantina; Memantine; Primary Health Care; Quality coding; Under-diagnosis