Affiliations: [a] Department of Medicine, University of Washington, Seattle, WA, USA
| [b] Department of Family Medicine, University of Washington, Seattle, WA, USA
| [c] School of Nursing, University of Washington, Seattle, WA, USA
| [d] Department of Epidemiology, University of Washington, Seattle, WA, USA
| [e] National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
Correspondence:
[*]
Correspondence to: Barak Gaster, 4245 Roosevelt Way NE, Seattle, WA 98105, USA. Tel.: +1 206 778 5157; E-mail: barakg@uw.edu.
Abstract: Background:The prevalence of Alzheimer’s disease and related disorders (ADRD) is rising. Primary care providers (PCPs) will increasingly be required to play a role in its detection but lack the training to do so. Objective:To develop a model for cognitive evaluation which is feasible in primary care and evaluate its implementation in a large health system. Methods:The Cognition in Primary Care Program consists of web-based training together with integrated tools built into the electronic record. We implemented the program among PCPs at 14 clinics in a large health system. We (1) surveyed PCPs to assess the impact of training on their confidence to evaluate cognition, (2) measured the number of cognitive assessments they performed, and (3) tracked the number of patients diagnosed with mild cognitive impairment (MCI). Results:Thirty-nine PCPs completed the training which covered how to evaluate cognition. Survey response rate from those PCPs was 74%. Six months after the end of the training, they reported confidence in assessing cognition (mean 4.6 on 5-point scale). Cognitive assessments documented in the health record increased from 0.8 per month before the training to 2.5 in the six months after the training. Patients who were newly diagnosed with MCI increased from 4.2 per month before the training to 6.0 per month in the six months after the training. Conclusions:This model for cognitive evaluation in a large health system was shown to increase cognitive testing and increase diagnoses of MCI. Such improvements are essential for the timely detection of ADRD.
Keywords: Alzheimer’s disease, cognitive dysfunction, continuing medical education, dementia, early detection of disease, mild cognitive impairment, primary care
