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The Effects of Computerized Cognitive Testing of Older Patients on Primary Care Physicians’ Approaches to Care: A Canadian Study

Tierney, Mary C. PhD; Charles, Jocelyn MD; Naglie, Gary MD; Jaakkimainen, Liisa MD; Moineddin, Rahim PhD

Alzheimer Disease & Associated Disorders: January–March 2017 - Volume 31 - Issue 1 - p 62–68
doi: 10.1097/WAD.0000000000000159
Original Articles

Background: We evaluated effects of providing primary care physicians (PCPs) with reports of their patients’ results on the Computer Assessment of Mild Cognitive Impairment (CAMCI) by examining their documented care approaches after receipt of the report.

Methods: Patients were 65 years and above, without a diagnosis or previous workup for dementia, seen consecutively over 2 months by one of 13 PCPs. PCPs indicated whether they, patients, or families had concerns about patients’ cognition. A total of 259 patients individually completed the CAMCI and results were provided to the PCP. Two raters blind to CAMCI results recorded care approaches documented by PCPs at the first visit within 3 months of report (n=181).

Results: In total, 28 different care approaches were grouped as related to Cognition or Safety/Self-Care. Negative binomial regression revealed that the number of care approaches was significantly associated with performance on the CAMCI for both Cognition and Safety/Self-care domains. These findings remained significant when covariates included PCPs’ cognitive concern before CAMCI results, and patients’ age, sex, number of comorbidities, and living arrangements.

Conclusions: Our findings indicate that PCPs documented more care approaches in patients with greater cognitive impairment based on the CAMCI results and this was independent of their, the patients’, or families’ prior concerns about their patients’ cognition.

Departments of *Family & Community Medicine

Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto

Primary Care Research Unit, Sunnybrook Health Sciences Centre

Primary Care and Population Health, Institute for Clinical Evaluative Sciences

Department of Medicine and Rotman Research Institute, Baycrest Health Sciences

§Research Department, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada

This research was funded by a research grant to M.C.T., G.N., R.M., J.C., and R.L.J. from the Alzheimer Society of Canada, Toronto, Canada. M.C.T and R.L.J. were each supported by Clinician Scientist Awards from the Department of Family & Community Medicine, University of Toronto. G.N. was supported by the George, Margaret and Gary Hunt Family Chair in Geriatric Medicine, University of Toronto. The CAMCI was purchased from the manufacturer with grant funding.

The authors declare no conflicts of interest.

Reprints: Mary C. Tierney, PhD, Primary Care Research Unit, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite E349, Toronto, ON, Canada M4N 3M5 (e-mail: mary.tierney@sunnybrook.ca).

Received February 5, 2016

Accepted May 19, 2016

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