Pharmacist-Physician Interprofessional Collaboration to Promote Early Detection of Cognitive Impairment: Increasing Diagnosis Rate.

Hernán Ramos,Esteve Puchades,Jordi Pérez-Tur,Andrés Navarro,Juan Pardo,Lucrecia Moreno,Rafael Sánchez

doi:10.3389/fphar.2021.579489

Abstract

The increased pressure on primary care makes it important for other health care providers, such as community pharmacists, to collaborate with general practitioners in activities related to chronic disease care. Therefore, the objective of the present project was to develop a protocol of action that allows close pharmacist-physician collaboration to carry out a coordinated action for very early detection of cognitive impairment (CI). Methods: A comparative study to promote early detection of CI was conducted in 19 community pharmacies divided into two groups: one group with interprofessional collaboration (IPC) and one group without interprofessional collaboration (NonIPC). IPC was defined as an interactive procedure involving all pharmacists, general practitioners and neurologists. A total of 281 subjects with subjective memory complaints were recruited. Three tests were used in the community pharmacies to detect possible CI: Memory Impairment Screening, Short Portable Mental State Questionnaire, and Semantic Verbal Fluency. Individuals with at least one positive cognitive test compatible with CI, were referred to primary care, and when appropriate, to the neurology service. Finally, we evaluated the differences in clinical and diagnostic follow-up in both groups after six months. Results: The NonIPC study group included 38 subjects compatible with CI referred to primary care (27.54%). Ten were further referred to a neurology department (7.25%) and four of them (2.90%) obtained a confirmed clinical diagnosis of CI. In contrast, in the IPC group, 46 subjects (32.17%) showed results compatible with CI and were referred to primary care. Of these, 21 (14.68%) were subsequently referred to a neurology service, while the remaining 25 were followed up by primary care. Nineteen individuals out of those referred to a neurology service obtained a confirmed clinical diagnosis of CI (13.29%). The percentage of subjects in the NonIPC group referred to neurology and the percentage of subjects diagnosed with CI, was significantly lower in comparison to the IPC group (p-value = 0.0233; p-value = 0.0007, respectively). Conclusions: The creation of IPC teams involving community pharmacists, general practitioners, and neurologists allow for increased detection of patients with CI or undiagnosed dementia and facilitates their clinical follow-up. This opens the possibility of diagnosis in patients in the very early stages of dementia, which can have positive implications to improve the prognosis and delay the evolution of the disease.

Highlights

The multidisciplinary CRIDECO Team of the CEU Cardenal Herrera University has been created to develop a protocol to screen individuals presenting at the community pharmacy with subjective memory complaints, and to subsequently set up a procedure to direct the individuals testing positive, in at least one of the tests, to their general practitioners first and to a neurologist in a hospital for precise diagnosis after that (Climent et al, 2018)
There were significant differences in the mean age of the NonIPC (x 70.94 years) with respect to the interprofessional collaboration (IPC) group (x 68.23), probably due to the multiple dissemination activities carried out that encouraged people to enroll in the project and the persistent publicity of the study in the city with IPC group
The NonIPC group presented 38 positive subjects compatible with cognitive impairment (CI) who were referred to primary care (27.54%)

Summary

Introduction

The improvements in health care during the last century have contributed to people having longer and healthier lives. This extension of life expectancy has produced an increase in the number of people with age-related diseases, such as dementia, that has resulted in a high demand and pressure on primary care services (World Health Organization [WHO], 2016). This pressure requires the implementation of new strategies to take advantage of all available stakeholders in the healthcare process. Primary healthcare can be seen to comprise of three main areas: empowering people and communities, fostering multi-sectoral policy and action, and primary care and essential public health functions as the core of integrated health services (WHO, 2020)

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