Primary care physicians' dementia care practices: evidence of geographic variation

Abstract

Purpose: This article explores primary care physicians' (PCPs) self-reported approaches and barriers to management of patients with dementia, with a focus on comparisons in dementia care practices between PCPs in 2 states.

Design and methods: In this cross-sectional study, questionnaires were mailed to 600 randomly selected licensed PCPs in Connecticut and to all 1,017 licensed PCPs in Maine.

Results: A total of 422 eligible PCPs responded. Nearly 90% of PCPs prescribed donepezil in the previous year for their dementia patients. Connecticut PCPs were more likely to prescribe several other therapeutics than their Maine counterparts. Connecticut PCPs were more likely to refer dementia patients to adult day care (85% vs. 59%) but less likely to refer to Area Agencies on Aging (21% vs. 44%; both ps < .05); referral rates to Alzheimer's Association chapters were low in both states (30%). A greater proportion of Connecticut PCPs reported barriers to optimal dementia care, including time constraints (54% vs. 31% of Maine PCPs), unfamiliarity with community resources (46% vs. 30%), and reimbursement constraints (45% vs. 23%; all ps <or= .05). Two thirds of PCPs were "very" or "somewhat" interested in using information technology to assist with dementia diagnosis and management; controlling for other variables, youngest PCPs were more than twice as likely as oldest to profess such interest (adjusted odds ratio = 2.04; 95% confidence interval [CI] = 1.02-4.08).

Implications: Geographic variations are evident in PCP medication prescription patterns, community resource referral patterns, and reported barriers to optimal dementia care. Younger PCPs are more likely to adopt information technology to assist in dementia diagnosis and management.