Can primary care record review facilitate earlier diagnosis of dementia?
Can primary care record review facilitate earlier diagnosis of dementia?
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DOI：
10.1093/fampra/cml068
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发表时间：
2007-04-01
期刊：
影响因子：
2.2
通讯作者：
Robinson, Louise
中科院分区：
文献类型：
--
作者：
Bamford, Claire;Eccles, Martin;Robinson, Louise
背景人们担心在初级保健中痴呆症的诊断延迟。目的探讨初级保健记录回顾是否有助于痴呆的早期诊断。回顾性病例对照研究。老年痴呆症患者（例）是通过英格兰东北部的老年精神病医生确定的。年龄和性别匹配的对照组在初级保健中确定。频率和地点的咨询，症状，介绍，测试和调查，管理，转介和选定的处方数据在5年前诊断为痴呆症。相关的症状，家庭成员的参与，不可预测的咨询模式和管理问题更有可能被记录在笔记的情况下比对照组。预测痴呆症后续诊断的关键变量包括没有护士和门诊咨询以及存在认知症状，与初级保健医生的咨询和转诊以澄清诊断或管理。回归模型在预测病例（敏感性= 80.2%）方面优于对照组（特异性= 69.8%）。将模型应用于典型的初级保健医生的列表将导致识别93个假阳性，以识别两个新的情况下，比目前发生的早18个月。咨询模式的差异可以在正式诊断痴呆症前4年观察到，这表明初级保健医生正在关注早期痴呆症的可能迹象。然而，这是不切实际的，使用系统的审查，初级保健记录，以促进早期诊断，而不确定大量的假阳性需要调查。
Background. There is concern over delayed diagnosis of dementia in primary care.Objective. To determine whether primary care record review can facilitate earlier diagnosis of dementia.Methods. Retrospective notes-based case-control study. Older people with dementia (cases) were identified through older age psychiatrists in the north-east of England. Age- and sex-matched controls were identified in primary care. Frequency and place of consultations, symptoms, presentation, tests and investigations, management, referrals and selected prescription data during the 5 years prior to the diagnosis of dementia were recorded.Results. Relevant symptoms, involvement of family members, unpredictable consulting patterns and problems with management were more likely to be recorded in the notes of cases than controls. Key variables predicting subsequent diagnosis of dementia included the absence of nurse and outpatient consultations and the presence of cognitive symptoms, consultations with primary care physicians and referral for clarification of diagnosis or management. Regression models were better at predicting cases (sensitivity = 80.2%) than controls (specificity = 69.8%). Applying the models to a typical primary care physician's list would result in the identification of 93 false positives in order to identify two new cases 18 months earlier than currently occurs.Conclusions. Differences in consultation patterns can be observed up to 4 years prior to formal diagnosis of dementia, indicating that primary care physicians are attending to possible signs of early dementia. However, it is not practicable to use the systematic review of primary care records to facilitate earlier diagnosis without identifying large numbers of false positives requiring investigation.