Exploring dementia management attitudes in primary care: a key informant survey to primary care physicians in 25 European countries

Background: Strategies for the involvement of primary care in the management of patients with presumed or diagnosed dementia are heterogeneous across Europe. We wanted to explore attitudes of primary care physicians (PCPs) when managing dementia: (i) the most popular cognitive tests, (ii) who had the right to initiate or continue cholinesterase inhibitor or memantine treatment, and (iii) the relationship between the permissiveness of these rules/guidelines and PCP's approach in the dementia investigations and assessment. Methods: Key informant survey. Setting: Primary care practices across 25 European countries. Subjects: Four hundred forty-five PCPs responded to a self-administered questionnaire. Two-step cluster analysis was performed using characteristics of the informants and the responses to the survey. Main outcome measures: Two by two contingency tables with odds ratios and 95 confidence intervals were used to assess the association between categorical variables. A multinomial logistic regression model was used to assess the association of multiple variables (age class, gender, and perceived prescription rules) with the PCPs' attitude of "trying to establish a diagnosis of dementia on their own". Results: Discrepancies between rules/guidelines and attitudes to dementia management was found in many countries. There was a strong association between the authorization to prescribe dementia drugs and pursuing dementia diagnostic work-up (odds ratio, 3.45; 95 CI 2.28-5.23). Conclusions: Differing regulations about who does what in dementia management seemed to affect PCP's engagement in dementia investigations and assessment. PCPs who were allowed to prescribe dementia drugs also claimed higher engagement in dementia work-up than PCPs who were not allowed to prescribe

Unburdening dementia a basic social process grounded theory – based on a primary care physician survey from 25 countries

OBJECTIVE: To explore dementia management from a primary care physician perspective.DESIGN: One-page seven-item multiple choice questionnaire; free text space for every item; final narrative question of a dementia case story. Inductive explorative grounded theory analysis. Derived results in cluster analyses. Appropriateness of dementia drugs assessed by tertiary care specialist.SETTING: Twenty-five European General Practice Research Network member countries.SUBJECTS: Four hundred and forty-five key informant primary care physician respondents of which 106 presented 155 case stories.MAIN OUTCOME MEASURES: Processes and typologies of dementia management. Proportion of case stories with drug treatment and treatment according to guidelines.RESULTS: Unburdening dementia - a basic social process - explained physicians' dementia management according to a grounded theory analysis using both qualitative and quantitative data. Unburdening starts with Recognizing the dementia burden by Burden Identification and Burden Assessment followed by Burden Relief. Drugs to relieve the dementia burden were reported for 130 of 155 patients; acetylcholinesterase inhibitors or memantine treatment in 89 of 155 patients - 60% appropriate according to guidelines and 40% outside of guidelines. More Central and Northern primary care physicians were allowed to prescribe, and more were engaged in dementia management than Eastern and Mediterranean physicians according to cluster analyses. Physicians typically identified and assessed the dementia burden and then tried to relieve it, commonly by drug prescriptions, but also by community health and home help services, mentioned in more than half of the case stories.CONCLUSIONS: Primary care physician dementia management was explained by an Unburdening process with the goal to relieve the dementia burden, mainly by drugs often prescribed outside of guideline indications. Implications: Unique data about dementia management by European primary care physicians to inform appropriate stakeholders. Key points Dementia as a syndrome of cognitive and functional decline and behavioural and psychological symptoms causes a tremendous burden on patients, their families, and society. •We found that a basic social process of Unburdening dementia explained dementia management according to case stories and survey comments from primary care physicians in 25 countries. •First, Burden Recognition by Identification and Assessment and then Burden Relief - often by drugs. •Prescribing physicians repeatedly broadened guideline indications for dementia drugs. The more physicians were allowed to prescribe dementia drugs, the more they were responsible for the dementia work-up. Our study provides unique data about dementia management in European primary care for the benefit of national and international stakeholders

Factors Affecting Reading Habit and Media Follow-Up in Turkey

AMAÇ: Okuma alışkanlığı ülkemizde dünya standartlarının oldukça altındadır. Bu çalışmada Türkiye'nin üç ilinde toplumumuzun okuma alışkanlığı, medya takibi ve bunları etkileyen faktörlerin araştırılması amaçlanmıştır. YÖNTEM: Bu kesitsel çalışmanın araştırma grubunu tıp fakültesi personeli ve öğrencileri ile ilköğretim okulları öğretmenleri ve öğrenci velileri oluşmuştur. Toplam 750 kişinin kendilerinin doldurduğu soru formlarından veriler elde edilmiştir. BULGULAR: Yaşları 16 ile 65 (31,75+10,19) yıl arasında değişen bireylerin %28,7'si öğrenci, %14,1'i ev hanımı, %7,9'u öğretim üyesi idi. Boş vakitlerini %25,6'sı TV izleyerek, %9,9'u bilgisayar kullanarak, %7,9'u okuyarak ve %16,7'si sinema/tiyatroya giderek değerlendirmekteydi. Grubun %41,7'si yılda 5 ve daha az kitap okurken, %10,7'si hiç kitap okumuyordu. %25,6'sı kendini geliştirmek için, %9,3'ü ise alışkanlık olarak kitap okuyordu. Okuyamama nedenleri %66,5 zamansızlık ve %10,8 ekonomik idi. Ekonomik durumu çok iyi olanların %61,4'ü yılda 6'dan fazla kitap okurken bu oran ekonomik durumu kötü olanlarda %22,2 idi ve fark anlamlı idi (p=0.000). Grubun %32,4'ü her gün gazete okuyor, %30,8'i ise her gün gazete alıyordu. İlköğretim mezunlarının %10,5'i her gün gazete alırken bu oran üniversite ve yüksek lisans mezunlarında %48,9 idi ve bu fark anlamlı idi (p:0.000). Ekonomik durumu çok iyi olanların %7'si gazete almaz iken bu oran ekonomik durumu kötü olanlarda %43,1 idi (p:0.000). Bireylerin %95,3'nün evinde televizyon vardı. İzlenen programlar sırasıyla en fazla haber programları (%35,7) ve dizilerdi (%34,5). Katılımcıların %16,6'sı hiç radyo dinlemez iken çoğunluğu sadece arabada veya evde iş yaparken dinlediğini ifade etmiştir. SONUÇ: Çalışmamız; Türkiye'nin üç farklı ilinde yapılmış olması, toplumumuzun farklı kesiminden insanlarını kapsaması ve düşük okuma alışkanlığı ve medya takibini bir kez daha vurgulanması açısından önemlidirAIM: Reading habit in our country is quite below the world standards. In this study, the aim was to investigate reading habit, and media follow-up of Turkey in three distinct provinces. METHOD: The research group of this cross-sectional study was composed of stuff and students of medical schools, teachers and parents of the students of primary schools in three provinces. Data were obtained from questionnaires self-filled by 750 people. RESULTS: Of the people whose ages ranged from 16 to 65 (31.75+10.19) years, 28.7% were students, 14.1% were house-wives, and 7.9% were lecturers. They spent their leisure time mostly by watching TV (25.6%), playing video/internet games (9.9%), reading books (7.9%), and merely going to cinema/theater (16.7%). Of the group, 41.7% read ?5 books per year, whereas 10.7% read no books at all. The reasons for not reading were lack of time (66.5%) and economical (10.8%). While 61.4% of those with very good economic status read >6 books per year, this rate was 22.2% among those with poor economic status, and the difference was significant (p=0.000). 32.4% were reading and 30.8% bought newspapers everyday. While 10.5% of primary school graduates bought newspapers every day, this rate was 48.9% among graduates of a university or a master degree (p=0.000). Seven percent of those with very good economic status bought no newspapers, whereas this rate was 43.1% among those with poor economic status (p=0.000). Of the people, 95.3% had a television at home. The most watched programs were the series (34.5%), and news programs (35.7%), respectively. 16.6% of the group did not listen to radio at all and the rest were listening only while driving or doing housework. CONCLUSION: Our study is important in terms of covering people from different sections of Turkish society and emphasizing the low reading habit and media follow-up once more