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Improving Diagnosis of Alzheimer's Disease and Related Dementia in Primary Care
Vautier, Elisa M
Vautier, Elisa M
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Abstract
Background: The number of Vermonters living with Alzheimer’s disease and related dementia (ADRD) is expected to increase by 42% to 17,000 by 2025. Missed and delayed diagnoses impact patient safety, treatment opportunities, and increase health care costs. This project assessed current practices of diagnosing ADRD in primary care, identified barriers to diagnosis, and developed and evaluated an evidence-based tool to assist in diagnosis and treatment of ADRD. Methods: Semi-structured interviews of 6 Vermont primary care nurse practitioners were conducted. Informed by themes in these interviews, an electronic health record “Smartphrase” was developed to assist NPs in diagnosis of ADRD. The Smartphrase includes a focused history of cognitive decline from patient and informant interviews; objective data; (laboratory and relevant screenings, medication reconciliation, physical exam), differential diagnoses of dementia, and resources for patient and family. Use of the ADRD Smartphrase was disseminated through an online educational video and evaluated by primary care nurse practitioners. Results: Interviews identified themes: 1. The absence of a standard pathway to diagnosis in primary care, 2. A reactive rather than proactive approach to diagnosis, and 3. Lack of identifiable resources for patient and family after diagnosis. The Smartphrase was evaluated by nurse practitioners (n=9). Pre- and post-survey responses supported ease of use and utility of the tool, and all respondents reported greater knowledge of available local support services. Conclusions: The ADRD Smartphrase was acceptable to a group of practicing nurse practitioners and was adapted by the Vermont Department of Health’s Committee on Alzheimer’s Disease for further dissemination.
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Date
2020-01-01