Clinician Beliefs and Practices in Dementia Care: Implications for Health Educators

Research on assessment and treatment of Alzheimer's disease (AD) is moving at a rapid pace. Continuing education (CE) providers must translate new findings for clinicians so as to enhance patient care. A two-page survey was distributed by mail to a sample of 5,000 licensed Missouri clinicians to gather data in support of this translation process. Clinicians were surveyed regarding their AD-related knowledge, their felt confidence and attitudes concerning dementia care, and their continuing education preferences. Respondents (n = 834) included primary care physicians (53%), advanced practice nurses (23%), specialist physicians (18%), and physician assistants (5%). Differences in knowledge and confidence levels were found across professional categories. Specialist physicians reported the highest scores. Rural providers largely did not differ from their urban counterparts. Respondents reported a greater preference for live, in-person programming than for technology-driven offerings (CD/DVD, satellite, Internet). CE providers can use such information to target programs to meet the learning needs and preferences of different clinician groups. This research was supported by a pilot research grant from the National Institute on Aging through the Alzheimer's Disease Research Center (ADRC), Department of Neurology, Washington University School of Medicine (NIA-P50-AG05681-18.4) and the Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Sciences University (P30–AG08017). The authors thank the faculty and staff of the ADRC for support and technical assistance for this project. Special thanks are due to research assistants, Erin Farlow and Rashida Byams, for managing the survey mailing and data entry processes. Notes 1The Missouri Department of Health (MODH) conducts a statewide survey of physicians at the same time each year. Their survey is mailed with license renewal forms to all licensed physicians statewide. Approximately 85% of physicians respond to this survey annually. The MODH list was chosen for the present effort because this list can be sorted by specialty category, whereas the MODPR list for physicians cannot. The use of the latter list would have meant that non-target physician groups (e.g., pediatricians) would have received the dementia care survey. 2This category includes both masters- and bachelors-prepared nurses with advanced training in adult, family, or geriatric work and who qualify for an Advanced Practice Nurse (APN) license from the Missouri State Board of Nursing. Those using this credential may use the titles of Advanced Practice Nurse or Clinical Nurse Specialist. 3There were less than 260 licensed physician's assistants (PA) in Missouri in 2000. To subdivide them would have made inter-group comparisons impossible. All but three of the 40 PA respondents reported seeing at least some older adults in their practices, suggesting some degree of self-selection favoring geriatric care. 4Rural providers, advanced practice nurses and physician assistants were over-sampled to ensure sufficient numbers for statistical comparisons based on practice population (urban vs. rural) and clinician type (e.g., physician vs. adv. practice nurse). aSummary statistics do not include missing values. Data reported for certain variables are collapsed across response categories for ease of presentation. For example, for the percentage of patients aged 65 and over, respondents actually included ten response choices (0%, 5, 10, 20, 30, … 80+). aThese statements are based on a subset of published practice parameters and guidelines from the American Academy of Neurology: (A) Doody et al., 2001; (B) Dubinsky et al., 2000; (C) included in response to other published evidence. The evidence-based direction for each (agree/ + vs. disagree/ − ) is indicated next to the reference letter. bNS = Not significant. Only differences where p < .001 are reported here. No significant differences were found based on geography of the practice (mainly urban vs. mixed vs. mainly rural). There was no clinician type × geography interaction. cThese items (D) reflect general attitudes (i.e., issues of interest for the authors) and are not necessarily tied to specific practice parameters. aNS = Not significant. Only differences where p < .001 are reported here. aMainly Urban Practice (10% or less rural); Mixed Practice (20–60% rural); Mainly Rural Practice (70 + % rural). bNS = Not significant. Assume p < .001 unless otherwise stated.