Variations in self-reported practice of physicians providing clinical care to individuals with dementia: a systematic review

Abstract

Objectives: To determine to what extent actual practice as reported in the literature is consistent with clinical guidelines for dementia care.

Design: A systematic review of empirical studies of clinical services provided by physicians to older adults with a diagnosis of dementia.

Setting: All settings involving primary care physicians in which a diagnosis of dementia is provided.

Participants: Physicians providing care to individuals aged 60 and older with a primary or secondary diagnosis of dementia.

Intervention: Seven dementia care processes recommended by guidelines: formal memory testing, imaging, laboratory testing, interventions, counseling, community service, and specialist referrals.

Measurements: Web of Knowledge, PubMed, Science Direct, MedLine, PsychINFO, EMBASE, and Google Scholar databases were searched for articles in English published before March 1, 2012.

Results: Twelve studies met the final inclusion criteria, all of which were self-reported cross-sectional surveys. There was broad variation in the proportion of physicians who reported conducting each dementia care process, with the widest variation in formal memory testing (4-96%). Recently published studies reflected a shift in scope of care, reporting that high proportions of physicians provided interventions, counseling, and referrals to specialist.

Conclusion: Despite the availability and dissemination of established best practice guidelines, there is still wide variation in physician practice patterns in dementia care. The quality of currently available studies limits the ability to draw strong conclusions. Better information on practice patterns and their relationship to outcomes for individuals with dementia and their caregivers using more-robust study designs is needed to address the needs of the increasing number of individuals who will require dementia care.

Keywords: dementia; doctor; health service; physician; practice pattern; systematic review; variation.