Article Figures & Data
Tables
- Table 1. Selected Sociodemographic Characteristics of Survey Respondents Compared to American Academy of Family Physicians (AAFP) Population (Overall Sample)
Sampled Respondent Characteristics Respondents (n) Respondents Compared to Overall Sample Test Results χ2 df P Clinician age (years) (n = 848 respondents) 3.12 3 .37 <40 119 14% vs. 15% 40–49 271 32% vs. 35% 50–59 331 39% vs. 37% ≥60 127 15% vs. 13% Sex (n = 851 respondents) 0.23 1 Female 255 30% vs. 31% Male 596 70% vs. 69% Time since medical school graduation (years) (n = 851 respondents) 6.69 3 .08 0–10 68 8% vs. 9% 11–20 289 34% vs. 40% 21–30 315 37% vs. 34% ≥31 179 21% vs. 18% Practice location (by Census region) (n = 843 respondents) 0.31 2 .86 Northeast 128 15% vs. 15% Midwest 238 28% vs. 28% South 278 33% vs. 34% West 196 23% vs. 22% Practice location (n = 843 respondents) 0.31 2 .86 Urban 169 20% vs. 21% Suburban 379 45% vs. 44% Rural 295 35% vs. 36% Percentage of time spent in direct patient care 851 90% vs. 89% Z = 2.43 .02 - Table 2. Physician Responses to Survey Items Related to Screening and Diagnostic Evaluation for Dementia
Screening/Diagnostic Evaluation Item “Yes” Responses, n (%) “Do you ever screen for dementia in asymptomatic adults?” (n = 851 were asked) 476 (56) Criteria used as decision rules for screening (n = 476 responded) Age 363 (76) Family history 344 (72) Other cerebrovascular risk factors 341 (72) Sex 56 (12) Use specific tools to screen (n = 476) 379 (80) Mini-mental status exam (379) 359 (95) Clock drawing test (379) 216 (57) Short portable mental status exam (379) 26 (7) “Do you conduct diagnostic evaluations based on early signs or symptoms, patient concerns, or caregiver concerns?” (n = 851 were asked) 762 (90) Screening and diagnostic evaluation status (n = 851 responded) Doctor does both 444 (52) Doctor conducts diagnostic evaluations only 318 (37) Doctor screens only 32 (4) Doctor does neither 57 (7) “If you obtain a positive screen or suspect dementia in a patient, do you follow-up with a more sensitive test in your office for presence of dementia?” (n = 794 were asked) 579 (73) “Do you routinely collect patient history as part of the diagnostic process?” (n = 794 were asked) 758 (95) “When you assess patient, do you routinely order lab work?” (n = 794 were asked) 739 (93) “When you diagnose a patient, do you routinely order brain imaging?” (n = 794 were asked) 527 (66) - Table 3. Physician Responses to Survey Items Related to Care of Patients with Dementia and Perceived Hard to Manage Phenomena
Treatment and Care Item “Yes” Responses, n (%) “Do you provide routine ongoing primary care for patients with dementia?” (n = 851were asked) 771 (91%) Hard to manage dementia-related behaviors and complications (n = 771 responses)* 1. Aggressiveness 579 (75) 2. Restlessness/agitation 493 (64) 3. Paranoia 452 (59) 4. Wandering 436 (57) 5. Sun-downing 329 (43) 6. Insomnia 229 (30) 7. Depression 185 (24) Comorbidities associated with dementia that are hard to manage(n = 771)† 1. Falls 515 (67) 2. Delirium 423 (55) 3. Adverse reactions to medications 346 (45) 4. Urinary incontinence 321 (42) 5. Poor appetite 304 (39) 6. Weight loss 289 (37) Family/caregiver problems associated with dementia (n = 771) 1. Fatigue/exhaustion 554 (72) 2. Planning for institutional placement 519 (67) 3. Anger 346 (45) 4. Isolation 296 (38) 5. Depression 218 (28) 6. Need for information 175 (23) Outcomes and Predictor Variables* Adjusted Odds Ratio Wald χ2 P (χ2 test) A. Order brain image as part screening or diagnostic evaluation for dementia (yes/no) Family/caregiver problems (n = 0–7) regarding dementia endorsed by respondent 1.09 2.47 .12 Professional time spent in direct patient care 1.01 3.06 .08 Time since medical school graduation (years) 1.01 1.08 .30 B. Assess positively screened patients ≥65 years old with more sensitive tests (yes vs. no) <5% vs. >40% 0.60 1.62 .20 5–20% vs. >40% 0.47 7.33 .007 21–40% vs. >40% 0.55 4.60 .03 Comorbidities (n = 0–6) associated with dementia endorsed by respondent 0.94 1.09 .30 Tools (n = 0–6) needed to diagnose/treat dementia endorsed by respondent 0.92 1.58 .21 C. Refer patients ≥65 years old with suspected dementia to other clinicians (yes vs. no) <5% vs. >40% 4.19 16.89 <.001 5–20% vs. >40% 2.94 19.05 <.001 21–40% vs. >40% 1.57 3.29 .07 Rural geographic location (vs. urban) 0.56 6.77 .009 Suburban geographic location (vs. urban) 0.84 0.72 .40 Female sex (vs. male) 1.31 2.56 .11 Dementia behaviors/complications (n = 0–7) endorsed by respondent 0.10 0.002 .10 Comorbidities (n = 0–6) associated with dementia endorsed by respondent 1.11 3.19 .07 Tools (n = 0–5) needed to diagnose/treat dementia endorsed by respondent 1.13 4.15 .04 ↵* Independent variables included within each model above are those found to be statistically significant (P ≤ .20) at the bivariate level with the given outcome. There were 11 independent variables for each outcome at the bivariate level.
