期刊
JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE
卷 23, 期 4, 页码 486-498出版社
AMER BOARD FAMILY MEDICINE
DOI: 10.3122/jabfm.2010.04.090225
关键词
Practice-based Research; PBRN; Dementia; Rural Health; Primary Health Care
资金
- Agency for Health care Research and Quality [R03 HS016007-01]
- National Institute on Aging [P30 AGO080]
- Oregon Clinical and Translational Research Institute
- National Center for Research Resources, National Institutes of Health [UL1 RR024140]
- National Institutes of Health Roadmap for Medical Research
Introduction: The aim of the Rural Older Adult Memory (ROAM) pilot study was to evaluate the feasibility of screening and diagnosing dementia in patients aged 75 years or older in 6 rural primary care practices in a practice-based research network. Methods: Clinicians and medical assistants were trained in dementia screening using the ROAM protocol via distance learning methods. Medical assistants screened patients aged 75 years of age and older. For patients who screened positive, the clinician was alerted to the need for a dementia work-up. Outcomes included change in the proportion of patients who were screened and diagnosed with dementia or mild cognitive impairment, clinician confidence in diagnosing and managing dementia, and response to the intervention. Results: Results included a substantial increase in screening for dementia, a modest increase in the proportion of patients who were diagnosed with dementia or mild cognitive impairment, and improved clinician confidence in diagnosing dementia. Although clinicians and medical assistants found the ROAM protocol easy to implement, there was substantial variability in adherence to the protocol among the 6 practices. Conclusion: This study demonstrated the complex issues that must be addressed in implementing a dementia screening process in rural primary care. Further study is needed to develop effective strategies for overcoming the factors that impeded the full uptake of the protocol, including the logistic challenges in implementing practice change and clinicians' attitudes toward dementia screening and diagnosis. (J Am Board Fam Med 2010;23:486-498.)
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