Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors.
Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors.
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DOI：
10.1097/wad.0b013e3181a6bebc
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发表时间：
2009-10
影响因子：
2.1
通讯作者：
Singh H
中科院分区：
文献类型：
--
作者：
Bradford A;Kunik ME;Schulz P;Williams SP;Singh H
痴呆症是一个日益严重的公共卫生问题，早期发现可能是有益的。目前，在初级保健中痴呆症的诊断主要依赖于基于患者监护人或照顾者的担忧的临床怀疑，并且容易被遗漏或延迟。我们对文献进行了系统的回顾，以确定初级保健中漏诊和迟发性痴呆诊断的患病率和影响因素。漏诊和延误诊断的患病率通过从初级保健提供者诊断敏感性研究中提取定量数据来估计。可能的预测因素和促成因素确定的定量和定性研究的患者，照顾者，供应商和系统相关的障碍的文本。诊断敏感性的总体估计值在研究中各不相同，并且似乎部分是痴呆严重程度、患者受损程度、痴呆亚型和患者-提供者接触频率的函数。主要影响因素包括态度和医患沟通问题、教育不足和系统资源限制。痴呆症漏诊和延迟诊断的真实患病率尚不清楚，但似乎很高。在痴呆症筛查变得更加引人注目之前，促进及时检测的努力应该集中在消除诊断障碍上。
Dementia is a growing public health problem for which early detection may be beneficial. Currently, the diagnosis of dementia in primary care is dependent mostly on clinical suspicion based on patient symptomsor caregivers’ concerns and is prone to be missed or delayed. We conducted a systematic review of the literature to ascertain the prevalence and contributing factors for missed and delayed dementia diagnoses in primary care. Prevalence of missed and delayed diagnosis was estimated by abstracting quantitative data from studies of diagnostic sensitivity among primary care providers. Possible predictors and contributory factors were determined from the text of quantitative and qualitative studies of patient-, caregiver-, provider-, and system-related barriers. Overall estimates of diagnostic sensitivity varied among studies and appeared to be in part a function of dementia severity, degree of patient impairment, dementia subtype, and frequency of patient-provider contact. Major contributory factors included problems with attitudes and patient-provider communication, educational deficits, and system resource constraints. The true prevalence of missed and delayed diagnoses of dementia is unknown but appears to be high. Until the case for dementia screening becomes more compelling, efforts to promote timely detection should focus on removing barriers to diagnosis.