Hostname: page-component-848d4c4894-wzw2p Total loading time: 0 Render date: 2024-05-14T21:05:04.845Z Has data issue: false hasContentIssue false

Examination of level of knowledge in Italian general practitioners attending an education session on diagnosis and management of the early stage of Alzheimer's disease: pass or fail?

Published online by Cambridge University Press:  28 January 2016

Federica Veneziani
Affiliation:
Neurodegenerative Diseases Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
Francesco Panza*
Affiliation:
Neurodegenerative Diseases Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy
Vincenzo Solfrizzi
Affiliation:
Geriatric Medicine-Memory Unit, Rare Disease Centre, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
Rosa Capozzo
Affiliation:
Neurodegenerative Diseases Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
Maria Rosaria Barulli
Affiliation:
Neurodegenerative Diseases Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
Antonio Leo
Affiliation:
Neurodegenerative Diseases Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
Madia Lozupone
Affiliation:
Neurodegenerative Diseases Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
Andrea Fontana
Affiliation:
Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
Simona Arcuti
Affiliation:
Neurodegenerative Diseases Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
Massimiliano Copetti
Affiliation:
Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
Valentina Cardinali
Affiliation:
Neurodegenerative Diseases Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
Alessandra Grasso
Affiliation:
Neurodegenerative Diseases Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
Marianna Tursi
Affiliation:
Neurodegenerative Diseases Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
Annalisa Iurillo
Affiliation:
Neurodegenerative Diseases Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
Bruno Pietro Imbimbo
Affiliation:
Research and Development, Chiesi Farmaceutici, Parma, Italy
Davide Seripa
Affiliation:
Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy
Giancarlo Logroscino
Affiliation:
Neurodegenerative Diseases Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
*
Correspondence should be addressed to: Francesco Panza, MD, PhD, Neurodegenerative Diseases Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy and Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy and Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy. Phone: +39 0807835692. Email: geriat.dot@geriatria.uniba.it.

Abstract

Background:

We detected the general level of knowledge about the early diagnosis of Alzheimer's disease (AD) and subsequent care in general practitioners (GPs) from Southern Italy. We explored also the GP perception about their knowledge and training on diagnosis and management of AD.

Methods:

On a sample of 131 GPs, we administered two questionnaires: the GP-Knowledge, evaluating GPs’ expertise about AD epidemiology, differential diagnosis, and available treatments, and the GP-QUestionnaire on Awareness of Dementia (GP-QUAD), assessing the GPs’ attitudes, awareness, and practice regarding early diagnosis of dementia.

Results:

Specific screening tests or protocols to diagnose and manage dementia were not used by 53% of our GPs. The training on the recognition of early AD signs and symptoms was considered inadequate by 55% of the participants. Females were more likely to consider their training insufficient (58%) compared to males (53%). Female GPs were less likely to prescribe antipsychotic drugs to control neuropsychiatric symptoms (NPS) and suggest specialist advice in late stage of cognitive impairment. Multiple Correspondence Analysis (MCA) performed only on GP-QUAD suggested two dimensions explaining 26.1% (“GP attitude”) and 20.1% (“GP knowledge”) of the inertia for a total of 46.2%,

Conclusion:

In our survey on GP clinical practice, several problems in properly recognizing early AD symptoms and subsequently screening patients to be referred to secondary/tertiary care centers for diagnosis confirmation have emerged. In the future, specific training programs and educational projects for GPs should be implemented also in Italy to improve detection rates and management of dementia in primary care.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahmad, S., Orrell, M., Iliffe, S. and Gracie, A. (2010). GPs' attitudes, awareness, and practice regarding early diagnosis of dementia. British Journal of General Practice, 60, e360–365. doi: 10.3399/bjgp10X515386.Google Scholar
Aisen, P. S. et al. (2011). Report of the task force on designing clinical trials in early (predementia) AD. Neurology, 76, 280286. doi: 10.1212/WNL.0b013e318207b1b9.Google Scholar
Albert, M. S. et al. (2011). The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the national institute on Aging–Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers & Dementia, 7, 270279. doi: 10.1016/j.jalz.2011.03.008.Google Scholar
Allen, M., Ferrier, S. and Sargeant, J. (2005). Alzheimer's disease and other dementias: an organisational approach to identifying and addressing practices and learning needs of family physicians. Educational Gerontology, 31, 521539. doi: 10.1080/03601270590962497.Google Scholar
Anderson, D. (2000). Forget me not—mental health service for older people. Audit Commission: London. Psychiatric Bulletin, 25, January 2001.Google Scholar
Beer, C. et al. (2009). Current experiences and educational preferences of general practitioners and staff caring for people with dementia living in residential facilities. BMC Geriatrics, 9, 36. doi: 10.1186/1471-2318-9-36.Google Scholar
Bond, J., Stave, C., Sganga, A., O'Connell, B. and Stanley, R. L. (2005). Inequalities in dementia care across Europe: key findings of the facing dementia survey. International Journal of Clinical Practice, 59, 814. doi: 10.1111/j.1368-504X.2005.00480.x.Google Scholar
Bowers, J., Jorm, A. F., Henderson, S. and Harris, P. (1990). General practitioners' detection of depression and dementia in elderly patients. The Medical Journal of Australia, 153, 192196.CrossRefGoogle ScholarPubMed
Bowers, J., Jorm, A. F., Henderson, S. and Harris, P. (1992). General practitioners' reported knowledge about depression and dementia in elderly patients. Australian & New Zealand Journal of Psychiatry, 26, 168174. doi: 10.3109/00048679209072024.CrossRefGoogle ScholarPubMed
Brodaty, H., Howarth, G. C., Mant, A. and Kurrle, S. E. (1994). General practice and dementia. A national survey of Australian GPs. The Medical Journal of Australia, 160, 1014.CrossRefGoogle ScholarPubMed
Buntinx, F., De Lepeleire, J., Paquay, L., Iliffe, S. and Schoenmakers, B. (2011). Diagnosing dementia: no easy job. BMC Family Practice, 12, 60. doi: 10.1186/1471-2296-12-60.CrossRefGoogle ScholarPubMed
Cahill, S., Clark, M., O'Connell, H., Lawlor, B., Coen, R. F. and Walsh, C. (2008). The attitudes and practices of general practitioners regarding dementia diagnosis in Ireland. International Journal of Geriatric Psychiatry, 23, 663669. doi: 10.1002/gps.1956.CrossRefGoogle ScholarPubMed
Cahill, S., Clark, M., Walsh, C., O'Connell, H. and Lawlor, B. (2006). Dementia in primary care: the first survey of Irish general practitioners. International Journal of Geriatric Psychiatry, 21, 319324. doi: 10.1002/gps.1464.CrossRefGoogle ScholarPubMed
Carter, R. E., Rose, D. A., Palesch, Y. Y. and Mintzer, J. E. (2004). Alzheimer's disease in the family practice setting: assessment of a screening tool. The Primary Care Companion to the Journal of Clinical Psychiatry, 6, 234238. doi: 10.4088/PCC.v06n0603.Google ScholarPubMed
Chang, C. Y. and Silverman, D. H. (2004). Accuracy of early diagnosis and its impact on the management and course of Alzheimer's disease. Expert Review of Molecular Diagnostics, 4, 6369. doi: 10.1586/14737159.4.1.63 Google Scholar
Cherry, D. L., Hahn, C. and Vickrey, B. G. (2009). Educating primary care physicians in the management of Alzheimer's disease: using practice guidelines to set quality benchmarks. International Psychogeriatrics, 21 (Suppl. 1), S44–52. doi: 10.1017/S1041610209008692.Google Scholar
Coley, N., Ousset, P. J., Andrieu, S., Matheix Fortunet, H. and Vellas, B. (2008). Memory complaints to the general practitioner: data from the GuidAge study. The Journal of Nutrition Health and Aging, 12, 66S–72S. doi: 10.1007/BF02982590.Google Scholar
De Lepeleire, J. et al. (2008). The primary care diagnosis of dementia in Europe: an analysis using multidisciplinary, multinational expert groups. Aging & Mental Health, 12, 568576. doi: 10.1080/13607860802343043.Google Scholar
Downs, M. (1996). The role of general practice and the primary care team in dementia diagnosis and management. International Journal of Geriatric Psychiatry, 11, 937942. doi: 10.1002/(SICI)1099-1166(199611)11:11<937::AID-GPS540>3.0.CO;2-0.3.0.CO;2-0>CrossRefGoogle Scholar
Downs, M. et al. (2006). Effectiveness of educational interventions in improving detection and management of dementia in primary care: cluster randomised controlled study. British Medical Journal, 332, 692696. doi: 10.1136/bmj.332.7543.692.Google Scholar
Edwards, R., Voss, S. E. and Iliffe, S. (2013). The development and evaluation of an educational intervention for primary care promoting person-centred responses to dementia. Dementia, (London) [Epub ahead of print]. doi: 10.1177/1471301213499768.Google Scholar
Greaves, I. and Jolley, D. (2010). National dementia strategy: well intentioned—but how well founded and how well directed?. British Journal of General Practice, 60, 193198. doi: 10.3399/bjgp10X483553.Google Scholar
Greenacre, M. J. (1984). Theory and Applications of Correspondence Analysis. New York: Academic Press.Google Scholar
Greenacre, M. J. (1993). Correspondence Analysis in Practice. London: Academic Press.Google Scholar
Hansen, E. C., Hughes, C., Routley, G. and Robinson, A. L. (2008). General practitioners' experiences and understandings of diagnosing dementia: factors impacting on early diagnosis. Social Science & Medicine, 67, 17761783. doi: 10.1016/j.socscimed.2008.09.020.Google Scholar
Hinton, L., Franz, C. E., Reddy, G., Flores, Y., Kravitz, R. L. and Barker, J. C. (2007). Practice constraints, behavioral problems, and dementia care: primary care physicians' perspectives. Journal of General Internal Medicine, 22, 14871492. doi: 10.1007/s11606-007-0317-y.Google Scholar
Iliffe, S. et al., DeNDRoN Primary Care Clinical Studies Group. (2009). Primary care and dementia: 1. diagnosis, screening and disclosure. International Journal of Geriatric Psychiatry, 24, 895901. doi: 10.1002/gps.2204.CrossRefGoogle ScholarPubMed
Iliffe, S. et al. (2012). Developing an educational intervention on dementia diagnosis and management in primary care for the EVIDEM-ED trial. Trials, 13, 142. doi: 10.1186/1745-6215-13-142.CrossRefGoogle ScholarPubMed
Iliffe, S., De Lepeleire, J., Van Hout, H., Kenny, G., Lewis, A. and Vernooij-Dassen, M.; DIADEM Group. (2005). Understanding obstacles to the recognition of and response to dementia in different European countries: a modified focus group approach using multinational, multi-disciplinary expert groups. Aging & Mental Health, 9, 16. doi: 10.1080/13607860412331323791.Google Scholar
Iliffe, S. and Wilcock, J. (2005). The identification of barriers to the recognition of, and response to, dementia in primary care using a modified focus group approach. Dementia, 4, 7385. doi: 10.1177/1471301205049191.Google Scholar
Iliffe, S., Wilcock, J. and Haworth, D. (2006). Obstacles to shared care for patients with dementia: a qualitative study. Family Practice, 23, 353362. doi: 10.1093/fampra/cmi116.Google Scholar
Kaduszkiewicz, H., Bachmann, C. and van den Bussche, H. (2008a). Telling “the truth” in dementia–do attitude and approach of general practitioners and specialists differ?. Patient Education and Counseling, 70, 220226. doi: 10.1016/j.pec.2007.10.010.Google Scholar
Kaduszkiewicz, H., Wiese, B. and van den Bussche, H. (2008b). Self-reported competence, attitude and approach of physicians towards patients with dementia in ambulatory care: results of a postal survey. BMC Health Services Research, 8, 54. doi: 10.1186/1472-6963-8-54.CrossRefGoogle ScholarPubMed
Koch, T. and Iliffe, S.; EVIDEM-ED project. (2010b). Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: a systematic review. BMC Family Practice, 11, 52. doi: 10.1186/1471-2296-11-52.Google Scholar
Koch, T. and Iliffe, S.; Evidem Programme. (2010a). The role of primary care in the recognition of and response to dementia. The Journal of Nutrition Health and Aging, 14, 107109. Doi: 10.1007/s12603-010-0021-1.Google Scholar
Lahjibi-Paulet, H., Dauffy Alain, A., Minard, A., Gaxatte, C., Saint-Jean, O. and Somme, D. (2012). Attitudes toward Alzheimer's disease: a qualitative study of the role played by social representation on a convenient sample of French general practitioners. Aging Clinical and Experimental Research, 24, 384390. doi: 10.1007/BF03325270.Google Scholar
Leifer, B. P. (2003). Early diagnosis of Alzheimer's disease: clinical and economic benefits. Journal of the American Geriatrics Societ, 51, S281S288. doi: 10.1046/j.1532-5415.5153.x.Google Scholar
McKhann, G. M. et al. (2011). The diagnosis of dementia due to Alzheimer's disease: recommendations from the national institute on aging–Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers & Dementia, 7, 263269. doi: 10.1016/j.jalz.2011.03.005.Google Scholar
Meeuwsen, E. J. et al. (2012). Effectiveness of dementia follow-up care by memory clinics or general practitioners: randomised controlled trial. BMJ, 344, e3086. doi: 10.1136/bmj.e3086.Google Scholar
Milne, A., Culverwell, A., Guss, R., Tuppen, J. and Whelton, R. (2008). Screening for dementia in primary care: a review of the use, efficacy and quality of measures. International Psychogeriatrics, 20, 911926. doi: 10.1017/S1041610208007394.Google Scholar
Moore, V. and Cahill, S. (2013). Diagnosis and disclosure of dementia–a comparative qualitative study of Irish and Swedish general practitioners. Aging & Mental Health, 17, 7784. doi: 10.1080/13607863.2012.692763.Google Scholar
Murphy, K. et al. (2014). Understanding diagnosis and management of dementia and guideline implementation in general practice: a qualitative study using the theoretical domains framework. Implementation Science, 9, 31. doi: 10.1186/1748-5908-9-31.Google Scholar
NICE/SCIE. (2006). Dementia: Supporting People with Dementia and Their Carers in Health and Social Care. London: National Institute for Clinical Excellence and Social Care Institute for Excellence (NICE/SCIE).Google Scholar
Olafsdóttir, M., Foldevi, M. and Marcusson, J. (2001). Dementia in primary care: why the low detection rate?. Scandinavian Journal of Primary Health Care, 19, 194198. doi: 10.1080/028134301316982469.Google Scholar
Panza, F., Logroscino, G., Imbimbo, B. P. and Solfrizzi, V. (2014). Is there still any hope for amyloid-based immunotherapy for Alzheimer's disease?. Current Opinion of Psychiatry, 27, 128137. doi: 10.1097/YCO.0000000000000041.Google Scholar
Petersen, R. C. et al. (2013). Mild cognitive impairment due to Alzheimer disease in the community. Annals of Neurology, 74, 199208. doi: 10.1002/ana.23931.CrossRefGoogle ScholarPubMed
Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W. and Ferri, C. P. (2013). The global prevalence of dementia: a systematic review and meta-analysis. Alzheimers & Dementia, 9, 6375. doi: 10.1016/j.jalz.2012.11.007.Google Scholar
Prokopiadou, D. et al. (2015). Translation and validation of a questionnaire to assess the diagnosis and management of dementia in Greek general practice. Evaluation & the Health Professions, 38, 151159. doi: 10.1177/0163278712474988.Google Scholar
Pucci, E. et al. (2004). General practitioners facing dementia: are they fully prepared?. Neurological Sciences, 24, 384389. doi: 10.1007/s10072-003-0193-0.CrossRefGoogle ScholarPubMed
Robinson, L., Vellas, B., Knox, S. and Lins, K. (2010). Clinical practice patterns of generalists and specialists in Alzheimer's disease: what are the differences, and what difference do they make?. The Journal of Nutrition Health and Aging, 14, 545552. doi: 10.1007/s12603-010-0266-8.Google Scholar
Rubin, S. M., Glasser, M. L. and Werckle, M. A. (1987). The examination of physicians’ awareness of dementing disorders. J Journal of the American Geriatrics Society, 35, 10511058. doi: 10.1111/j.1532-5415.1987.tb04920.x.Google Scholar
Sperling, R. A. et al. (2011). Toward defining the preclinical stages of Alzheimer's disease: recommendations from the national institute on Aging–Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers & Dementia, 7, 280292. doi: 10.1016/j.jalz.2011.03.003.Google Scholar
Teel, C. S. (2004). Rural practitioners’ experiences in dementia diagnosis and treatment. Aging & Mental Health, 8, 422429. doi: 10.1080/13607860410001725018.Google Scholar
Trenkle, D. L., Shankle, W. R. and Azen, S. P. (2007). Detecting cognitive impairment in primary care: performance assessment of three screening instruments. Journal of Alzheimer's Disease, 11, 323335.Google Scholar
Tsolaki, M. et al., European Alzheimer Disease Consortium. (2010). Consensus statement on dementia education and training in Europe. The Journal of Nutrition, Health & Aging, 14, 131135. doi: 10.1007/s12603-009-0238-z.Google Scholar
Turner, S. et al. (2004). General practitioners’ knowledge, confidence and attitudes in the diagnosis and management of dementia. Age and Ageing, 33, 461467. doi: 10.1093/ageing/afh140.Google Scholar
van Hout, H., Vernooij-Dassen, M., Bakker, K., Blom, M. and Grol, R. (2000b). General practitioners on dementia: tasks, practices and obstacles. Patient Education and Counseling, 39, 219225.Google Scholar
van Hout, H., Vernooij-Dassen, M., Poels, P., Hoefnagels, W. and Grol, R. (2000a). Are general practitioners able to accurately diagnose dementia and identify Alzheimer's disease? A comparison with an outpatient memory clinic. British Journal of General Practice, 50, 311312.Google ScholarPubMed
Villars, H. et al. (2010). The primary care physician and Alzheimer's disease: an international position paper. The Journal of Nutrition, Health & Aging, 14, 110120. doi: 10.1007/s12603-010-0022-0.Google Scholar
Werner, P. (2007). Family physicians’ recommendations for help-seeking for a person with Alzheimer's disease. Aging Clinical and Experimental Research, 19, 356363. doi: 10.1007/BF03324715.Google Scholar
Wijeratne, C. and Harris, P. (2009). Late life depression and dementia: a mental health literacy survey of Australian general practitioners. International Psychogeriatrics, 21, 330337. doi: 10.1017/S1041610208008235.CrossRefGoogle ScholarPubMed
Wilcock, J. et al. (2013). Tailored educational intervention for primary care to improve the management of dementia: the EVIDEM-ED cluster randomized controlled trial. Trials, 14, 397. doi: 10.1186/1745-6215-14-397.Google Scholar
Wilkinson, D., Stave, C., Keohane, D. and Vincenzino, O. (2004). The role of general practitioners in the diagnosis and treatment of Alzheimer's disease: a multinational survey. The Journal of International Medical Research, 32, 149159. doi: 10.1177/147323000403200207.Google Scholar
Wolff, L. E., Woods, J. P. and Reid, J. (1995). Do general practitioners and old age psychiatrists differ in their attitudes to dementia?. International Journal of Geriatric Psychiatry, 10, 6369. DOI: 10.1002/gps.930100112.CrossRefGoogle Scholar