Primary Care Physicians In Order Research Articles

Knowledge, attitudes, beliefs and practices of pregnant women towards the influenza vaccine in Trinidad.

Pregnant women and their babies are at increased risk of influenza-related complications. The World Health Organisation recommends influenza vaccination to this high-risk population as the highest priority. A knowledge, attitudes,beliefs, and practices (KAP) of pregnant women towards the influenza vaccine in Trinidad. It was disseminated to 480 pregnant women attending the clinic and completed by 146 yielding a response rate of 30%. Women who received the vaccine in a past pregnancy were nine times more likely to consider taking the vaccine in the current pregnancy. There was a statistically significant difference in vaccine uptake based on the source of information received by participants about the influenza vaccine (χ2 (3) = 9.864, P = 0.020), with the highest mean score for uptake shown in women who received information from a health care provider. A moderate, positive correlation was found between knowledge and vaccine uptake (rs (143) =0.430, P < 0.01), a weak, positive correlation between perceived susceptibility and vaccine uptake (rs (143) = 0.264, P < 0.01), and a weak, positive correlation between knowledge and perceived susceptibility (rs (143) = 0.229, P < 0.01). The study findings highlight that the source of information significantly influences vaccine uptake, with health care providers being the most influential source. This underscores the role of primary care physicians in providing accurate and up-to-date information about influenza vaccination to pregnant women. There is a need for accurate information and recommendations to be given to pregnant women by all health care workers including primary care physicians in order to increase vaccine uptake and reduce maternal and neonatal morbidity and mortality.

Psychoemotional risk factors for non-communicable diseases in outpatient practice. Guidelines for internists

Methodological guidelines "Psychoemotional risk factors in outpatient practice" were developed as a practical document for primary care physicians in order to expand and improve knowledge, as well as provide care to the adult population within the studied theme. The methodological guidelines include an information and content part for medical specialists and a practical part for patients, presented in the format of memos. The guidelines include the main sections: definition, structure and epidemiology of psychoemotional risk factors, psychoemotional risk factors in the clinics of internal diseases, screening of psychoemotional risk factors, prevention and correction of psychoemotional risk factors for noncommunicable diseases, non-drug care for patients, pharmacotherapy of psychoemotional disorders. The guidelines are intended for primary care physicians, for specialists who develop and implement educational programs for patients, as well as for therapeutic residents.

Abstract PS7-71: Breast cancer fast-track programme to shorten time between initial symptoms, diagnosis and initiation of treatment. 10 years update

Abstract Background: Breast cancer (BC) is one of the most serious health problems worldwide. The implementation of screening programs as well as advances in diagnosis and therapeutics have achieved an increase in survival. However, there are patients who do not benefit from screening programs: very young or older than 69 years old patients and interval cancers.The main aim of this breast cancer fast-track program (BCFP) is to reduce the time from the onset of breast cancer signs and symptoms until the beginning of treatment. · Methods: The programme began in June 2009; we hereby present data from the first ten years (June 2009-June 2019) in the Clinico-Malvarrosa Health Department in Valencia, Spain. Breast surgeons, primary care (PC) physicians, radiologists who are experts in breast cancer and oncology coordinators regularly met to discuss suspected cases of BC, and initially set guidelines with the criteria to be used by PC physicians in order to refer patients to BCFP. On the same day that the PC physician identified a patient with suspected BC, an index card was sent to the oncology coordinator, who reviewed these cases and referred those meeting previously defined criteria to either breast surgeons or breast radiologists. · Results: 1849 proposals were sent to the hospital from which 1778 patients came to the first visit at the specialist. 312 (16.9%) referred cases were diagnosed with BC. 206 (66%) women were diagnosed of BC in the age range in which screening with mammography is not recommended in our general population (between 45-69 years old). 296 patients had a localized BC (94%) and 16 (6%) an advanced BC. The median time from submission of a proposal until the specialist assessment was 13 days for diagnosed patients, 2 days from the first visit to histopathological diagnosis, and 29 days from the histopathological diagnosis until a treatment is initiated (either oncological or surgical). It took a median of 18 days to confirm the absence of BC in 1466 patients with initial suspicion of it. • Conclusions: Our data show that the time interval between patient referral by the PC physician to the specialist, diagnosis of breast cancer, and start of therapy can be reduced. We optimized existing resources with no additional costs associated with the implementation of this programme. Keywords: Breast Cancer, Clinical Guidelines, Early diagnosis Authors: M.T. Martinez1*, S. Moragon1*, S. Simón1, B. Ortega1, J.V. Montón1, J. Navarro2, A. Sanmartin2, A. Julve3, E. Buch4, O. Burgues5, C. Hernando1, J. M. Cejalvo1, A. Lluch1, B. Bermejo1, A. Cervantes1, I. Chirivella1.1Medical Oncology Department, INCLIVA Biomedical Research Institute, Valencia, Spain, 2Management department, Hospital Clinico Universitario de Valencia, Valencia, Spain3 Radiodiagnosis Department, Hospital Clinico Universitario de Valencia, Valencia, Spain4 Senology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain5 Pathological Anatomy Department. Hospital Clinico Universitario de Valencia, Valencia, Spain Citation Format: Maria Teresa Martínez, Santiago Moragon, Soraya Simon, Belen Ortega, Jose Vicente Monton-Bueno, Jorge Navarro, Ana Sanmartin, Ana Julve, Elvira Buch, Octavio Burgués, Cristina Hernando, Juan Miguel Cejalvo, Ana Lluch, Begoña Bermejo, Andrés Cervantes, Isabel Chirivella. Breast cancer fast-track programme to shorten time between initial symptoms, diagnosis and initiation of treatment. 10 years update [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-71.

Appropriateness of colonoscopy at a tertiary care centre - are we overdoing gastrointestinal endoscopy?

Aim To evaluate the pattern of indications and a spectrum of colonic pathology, and to determine appropriateness of indications for colonoscopy in order to improve patient selection for colonoscopy. Methods This retrospective study includes 294 patients who were referred to the Gastroenterology Department from a primary care physician in order to approach endoscopic examination. Study data included patients' anamnestic data (comorbidities, positive family history, performed radiological examinations) an indication for the procedure, and colonoscopy findings. Results Haematochezia was confirmed in 186 (63.26%), positive radiologic finding in183 (62.24%) and anaemia in 157 (53.40%) patients. Adenoma and colorectal carcinoma were detected in 40 (13.6%) and 53 (18%) patients, respectively. A significant association between haematochezia and colorectal neoplasm was confirmed (p=0.019), haematochezia and inflammatory bowel disease (p=0.027), and between radiological finding and colorectal neoplasm (p=0.018). There was no significant association between anaemia and any of the colonoscopic findings. According to EPAGE II criteria indications were appropriate in 187 (63.6%), uncertain in 67 (22.8%) and inappropriate in 40 (13.6%) patients. Conclusion This study confirmed a slightly larger number of uncertain and inappropriate indications for colonoscopy compared to other studies that examined indications for colonoscopy, which can be attributed to a high number of patients with functional bowel disorders.

Work up of fatty liver by primary care physicians, review.

Nonalcoholic fatty liver disease (NAFLD) is an overarching term that refers to abnormal deposition of lipids in the liver and is used to describe the spectrum of disease ranging from hepatic steatosis to nonalcoholic steatohepatitis to cirrhosis. NAFLD is the most common cause of chronic liver disease and the second most common cause of cirrhosis. Although the pathophysiology is not completely understood, there is a strong link between NAFLD and metabolic syndrome. This review focuses on the workup of NAFLD in the primary care setting, from differential diagnoses to assessing fibrosis via predictive models that use commonly used laboratory values, biomarkers, and imaging. The purpose of this review article is to provide a set of screening and diagnostic tools for all primary care physicians in order to better manage patients with NAFLD.

Cystic fibrosis knowledge and practice among primary care physicians in southwest region, Saudi Arabia.

Introduction:Cystic fibrosis (CF) is a multisystem autosomal recessive disease that affects 1 in 4,000 newborns in the United States and has high mortality and morbidity. In the Middle East, there is no exact estimation of CF prevalence and the survival rate is almost 50% of the reported survival in the developed countries. In this study, I aimed to determine the CF knowledge and practice (CF-KP) among primary care physicians (PCPs) and to propose effective educational programs to recognize children who suffer from CF early on and refer them to appropriate tertiary centers.Materials and Methods:This was a cross-sectional study among PCPs in the Aseer region. The principal investigator designed and formulated the used CF-KP questionnaire in this study. It was developed in the English language and distributed through Google and printed forms. Each question included right and wrong answers with the ability to choose more than one option. There were three categories for each question either answer completely, incompletely, or wrong answer.Results:Fifty-one PCPs were recruited and successfully completed the questionnaire. Around two-thirds of the responders were less than 40 years old while few were older than 50 years. The majority of the responding doctors were male 82.4% (42 out of 51) and have been practicing clinical medicine more than 5 years after graduation. The overall knowledge score percent was 56.7% with a mean of 20.4, maximum 31, and minimum 4, while the overall practice score percent was 68% with a mean of 3.4 and maximum and minimum scores were 5 and 1, respectively.Discussion:This study is the first study that assessed the CF-KP among PCPs in the Aseer region. The total score percent of knowledge and practice among the studied group were 56% and 68%, respectively. Around 20% of the responding physicians knew when to refer suspected cases of CF to a tertiary center for further diagnostic and therapeutic interventions. Most of the responders in this study did not know the long-term complications of CF and they did not think that it is a progressive disease and eventually cause death if untreated.Conclusion:This study highlighted the need for extensive educational programs for the PCPs in order to improve early recognition of CF and start the appropriate management. In the era of CF modulators and correctors, CF providers should maximize the other therapies to improve the outcomes and prevent long-term morbidities and mortalities.

1658P - Selection of a set of quality indicators (QI) for oncological clinical pathway

BackgroundClinical pathways in oncology have become increasingly complex, involving several different healthcare professionals inside and outside the hospital setting who need particular coordination to provide appropriate care for patients. Very few QI exist to evaluate the oncological clinical pathway in its entirety, particularly regarding the various stages between patient admissions and discharges and the liaisons with non-hospital healthcare professionals (e.g. GPs, pharmacists). Our objective is to select a number of QI describing the oncological clinical pathway with an expert panel. MethodsA systematic review of available QI describing the oncological clinical pathways in the literature was conducted. The list of selected QI was presented to an expert panel (oncologists, pharmacists and SRNs) of various hospitals in France. The selection involved a two-step process: a preliminary selection was conducted based on the title and rationale of the QI by consensus (nominal group), assigning a value to each QI reviewed on the basis of its appropriateness and its feasibility (1st working group). The pre-selected QI were then described in detail and presented to the expert panel (2nd working group) in order to validate the selection. Results5731 QI were identified in the literature review and 131 included. 17 indicators were pre-selected by the experts (1st working group). After presentation of the 17 detailed descriptors, the QIs were clustered or eliminated. Ultimately, 10 QI were selected (Table): outcome (2), process (3) and structure (5).Table: 1658PTable: 1658PQIDescriptionType1Symptoms and disease progressionStructure2Assessment of tolerance to treatmentProcess3Management of patients receiving oral therapyStructure4Quality of the liaison documentProcess5Composite score for supportive careStructure6Patient therapeutic educationStructure7Medication reconciliationProcess8Unscheduled admissionsOutcome9Declaration and follow-up upon serious adverse events in clinical pathwayStructure10Patient’s experience (PREMS)Outcome ConclusionsThis approach will be developed further by presenting the IQs to patient associations and primary care physicians in order to gather their feedback, refine, adapt and ultimately create a representative set of indicators. Legal entity responsible for the studyThe authors. FundingNovartis Oncology France. DisclosureAll authors have declared no conflicts of interest.

Recurrent diabetic ketoacidosis.

The purpose of this study is to examine risk factors for recurrence of diabetic ketoacidosis and determine interventions to prevent future admissions. Review article. Recurrent diabetic ketoacidosis is a serious and not uncommon health problem. Diabetic ketoacidosis is associated with severe morbidity and mortality and hospital admissions due to this problem constitute a serious economic burden on the healthcare system. Younger age at diabetic ketoacidosis onset, poor baseline glycemic control and elevated HbA1C, patient comorbidities, depression, alcohol or substance abuse, particularly active cocaine use, have been associated with recurrent diabetic ketoacidosis. In addition, socioeconomic factors (such as ethnic minority status, use of public health insurance and underinsurance), psychosocial, economic, and behavioral factors (including financial constraint, stretching a limited insulin supply, and homelessness) have been all reported to be associated with readmission among diabetic ketoacidosis patients. Identifying high-risk patients during the first diabetic ketoacidosis admission and performing relevant interventions (repeated instructions of insulin use, social help and involvement of family members in medical treatment, collaboration with the patient's primary care physician in order to establish a close and frequent follow up program) may help prevent future admissions. Further studies need to take place to determine whether early interventions with those factors prevent future admissions.

Diagnostic utility and impact of ultrasonography by primary health care physician: an observational study

Background: Ultrasound appears to be a suitable diagnostic technology for use in primary care and community settings. It plays a pivotal role in evaluation of patients and helps in making timely diagnosis and more widely on referral pathways into secondary care.Methods: The study was conducted at the primary health centre Hazratbal, which is one of the primary health centre of field practice area of the Department of community medicine, Government Medical College, Srinagar. This observational study was conducted over a period of three months where 255 patients were scanned by a primary care physician (sonologist). For each patient scanned, the ultrasound performing physician completed a standardized data collection form including patient demographics, clinical details, indications for ultrasound and ultrasound findings.Results: A total of 255 patients were scanned during the study period. Males were 43 (17%) and females were 212 (83%). Maximum number of patients were in the age range of 25-34 years, n=96 (38%). Among the patients scanned 66 (24.44%) were obstetric cases. Acute diffuse abdominal pain n=32 (11.85%) was the most common clinical presentation followed by pain upper abdomen n=28 (10.37%) among non-obstetric patients. Ovarian cyst was the most common finding, followed by fatty liver and bilateral nephrolithiasis.Conclusions: The utility of ultrasonography in the hands of primary care physician is of great value. It is cost effective option, especially in this part of the world. We need to give expertise to primary care physicians in order to provide better health care at primary health care settings, which will lessen the burden of referrals.

Contact Dermatitis after Prescription of an Ophthalmic Ointment Containing Fradiomycin Sulfate: A Retrospective Database Study Using Japanese Health Insurance Claims Data.

BackgroundTopical ointments containing fradiomycin sulfate, such as fradiomycin sulfate/methylprednisolone (F/M) and fradiomycin sulfate/betamethasone sodium phosphate (F/B), are known to cause allergic contact dermatitis (CD) in some patients, especially when used for the periocular region. F/M is commonly prescribed to patients for various conditions; however, there are no reports with respect to the incidence of CD caused by F/M in actual practice.ObjectiveThe aim was to investigate the incidence of CD using a data-based retrospective cohort study.MethodsUsing a Japanese health insurance claims database [MinaCare Co. Ltd. healthcare database (MinaCare HDB)], a comparative assessment was conducted of F/M and another combination drug (F/B) and two single-drug treatments (ophthalmic ointments with either an antibiotic or a steroid). The total data set consisted of 1,176,082 individuals in the MinaCare HDB, with 54,016 having received prescriptions for one of the four investigational drug regimens.ResultsOverall, the incidences of CD were similar in three of the four groups in this study (F/M 0.091; F/B 0.092; steroids 0.102), while being lower in the fourth group (antibiotics 0.060). Even after confirmation of a diagnosis of CD, prescriptions for the investigational drugs were repeatedly filled for some patients.ConclusionThis study demonstrated that there was no clear difference in the incidence of CD after filling prescriptions for F/M, F/B, and ophthalmic ointment containing a steroid, while the incidence with antibiotics was lower by 0.03–0.04 compared with the other groups. Considering the observation that the investigational drugs were repeatedly prescribed even after the diagnosis of CD, it is critical that the risk of CD with these prescribed topical ointments is better understood by primary care physicians in order to take appropriate countermeasures.

Tratamento da Gota na Atenção Primária à Saúde

Objetivo: O objetivo desta revisão é fornecer informação atualizada e orientações práticas sobre a abordagem da gota na Atenção Primária à Saúde. Métodos: Foram pesquisadas normas de orientação clínica, revisões sistemáticas, meta-análises e estudos originais publicados entre 1 janeiro de 2011 e 31 dezembro de 2016, nas línguas inglesa, portuguesa e espanhola. Resultados: Os fármacos de primeira linha no tratamento da gota aguda são os anti-inflamatórios não esteroides, a colchicina e os corticoides, em monoterapia ou associação. Na gota crônica são usados hipouricemiantes, sendo a primeira linha o alopurinol. O febuxostate e os uricosúricos são alternativas ao alopurinol em casos de intolerância ou ineficácia. A profilaxia das crises de gota agudas está recomendada quando se inicia o tratamento hipouricemiante durante pelo menos 6 meses. Conclusão: A abordagem correta da gota deve fazer parte das competências de um médico especialista em Atenção Primária à Saúde de modo a prestar cuidados adequados à comunidade.

Prevalence and clinical implications of psychopathology in adults with epilepsy seen in an outpatient clinic in Nigeria

BackgroundThe psychopathological and clinical characteristics of adult patients with epilepsy attending our neurology clinic were evaluated to determine prevalence of psychopathology and its associated factors towards improving services and initiating collaborative care which is currently nonexistent. MethodsThe study was a two-stage procedure conducted over 1 year using the General Health Questionnaire in the first stage and Schedule for Clinical Assessment in Neuropsychiatry in the second stage. Diagnosis of psychiatric disorders was based on International Classification of Diseases: 10th Revision criteria. ResultsSixty-three patients were interviewed. Mean age was 34.43 ± 13.7 years; more than half of the patients had less than one seizure episode per month. Fourteen patients (22.2%) had partial epilepsy; 40 (63.5%), generalized; and 9 (14.3%), unclassified seizures. The rate of psychiatric morbidity was found to be 28.6%. Depressive disorders were the most common (66.7%), followed by psychotic disorders (11.1%), anxiety disorders (11.1%) and dementia (11.1%). Psychopathology was more common in women (P=.007), those older than 40 years (P=.038) and those with partial epilepsy (P=.017). ConclusionAbout one third of patients with epilepsy studied had undetected and untreated psychopathology. Our neurology clinic urgently needs currently nonexistent collaborative care involving neurologists, psychiatrists and primary care physicians in order to improve the mental health of the patients with epilepsy.

AB0303 Osteoarthritis is the Most Frequent Cause of Rheumathoid Arthritis Misdiagnosis in A Colombian Specialized Center

BackgroundThere is a lack of expertise in the rheumatoid arthritis (RA) diagnosis in primary level medical centers in Colombia. Frequently, patients with osteoarthritis (OA) are misdiagnosed as rheumatoid arthritis (RA)...

Design and implementation of an automated email notification system for results of tests pending at discharge

Physicians are often unaware of the results of tests pending at discharge (TPADs). The authors designed and implemented an automated system to notify the responsible inpatient physician of the finalized results of TPADs using secure, network email. The system coordinates a series of electronic events triggered by the discharge time stamp and sends an email to the identified discharging attending physician once finalized results are available. A carbon copy is sent to the primary care physicians in order to facilitate communication and the subsequent transfer of responsibility. Logic was incorporated to suppress selected tests and to limit notification volume. The system was activated for patients with TPADs discharged by randomly selected inpatient-attending physicians during a 6-month pilot. They received approximately 1.6 email notifications per discharged patient with TPADs. Eighty-four per cent of inpatient-attending physicians receiving automated email notifications stated that they were satisfied with the system in a brief survey (59% survey response rate). Automated email notification is a useful strategy for managing results of TPADs.

Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians

BackgroundThe Spanish Palliative Care Strategy recommends an intermediate level of training for primary care physicians in order to provide them with knowledge and skills. Most of the training involves face-to-face courses but increasing pressures on physicians have resulted in fewer opportunities for provision of and attendance to this type of training. The effectiveness of on-line continuing medical education in terms of its impact on clinical practice has been scarcely studied. Its effect in relation to palliative care for primary care physicians is currently unknown, in terms of improvement in patient's quality of life and main caregiver's satisfaction. There is uncertainty too in terms of any potential benefits of asynchronous communication and interaction among on-line education participants, as well as of the effect of the learning process.The authors have developed an on-line educational model for palliative care which has been applied to primary care physicians in order to measure its effectiveness regarding knowledge, attitude towards palliative care, and physician's satisfaction in comparison with a control group.The effectiveness evaluation at 18 months and the impact on the quality of life of patients managed by the physicians, and the main caregiver's satisfaction will be addressed in a different paper.MethodsRandomized controlled educational trial to compared, on a first stage, the knowledge and attitude of primary care physicians regarding palliative care for advanced cancer patients, as well as satisfaction in those who followed an on-line palliative care training program with tutorship, using a Moodle Platform vs. traditional education.Results169 physicians were included, 85 in the intervention group and 84 in the control group, of which five were excluded. Finally 82 participants per group were analyzed. There were significant differences in favor of the intervention group, in terms of knowledge (mean 4.6; CI 95%: 2.8 to 6.5 (p = 0.0001), scale range 0-33), confidence in symptom management (p = 0.02) and confidence in terms of communication (p = 0.038). Useful aspects were pointed out, as well as others to be improved in future applications. The satisfaction of the intervention group was high.ConclusionsThe results of this study show that there was a significant increase of knowledge of 14%-20% and a significant increase in the perception of confidence in symptom management and communication in the intervention group in comparison with the control group that received traditional methods of education in palliative care or no educational activity at all. The overall satisfaction with the intervention was good-very good for most participants.This on-line educational model seems a useful tool for palliative care training in primary care physicians who have a high opinion about the integration of palliative care within primary care. The results of this study support the suggestion that learning effectiveness should be currently investigated comparing different Internet interventions, instead of Internet vs. no intervention.Trial RegistrationGerman Clinical Trials Register DRKS00000694

Identifying Primary Care Skills and Competencies in Opioid Risk Management

Primary care physicians (PCPs) treat a high proportion of chronic pain patients but often lack training about how to assess and address issues associated with prescribing opioids when they are an appropriate component of therapy. The result may be that they may avoid treating these patients, which can lead to an undertreatment of pain. The objective of this study was to identify which skills and competencies are most critical for PCPs in order to effectively manage opioid risk in patients treated for chronic pain. We conducted 1-hour interviews with 16 nationally known experts in primary care, pain management, and addiction. Eight were trained as PCPs, and 8 were trained as specialists. Their responses were collated and then presented online to the participants for independent sorting and rating. These data were analyzed using an online concept mapping program, which offers an innovative method of summarizing and prioritizing qualitative data. Based on this analysis, items were organized into 10 clusters representing the most critical categories of skills (the "best fit" for these data). The cluster that received the highest average statement rating was "How to Manage Pain Patients With Comorbid Conditions." Follow-up analyses indicated that specialists rated this cluster, and 5 others, significantly higher than the PCPs, suggesting that the specialists perceive these competencies as more important in opioid risk management. Using a relatively small sample and cost-effective technique (ie, concept mapping), key PCP competencies can be identified for potential inclusion in continuing education and training in opioid risk management.

Payment Reform to Finance a Medical Home

This commentary on R. F. Averill et al. (2010) addresses their idea of risk and quality adjusting fee-for-service payments to primary care physicians in order to improve the efficiency of primary care and take a step toward financing a "medical home"for patients. I show how their idea can create incentives for efficient practice styles. Pairing this with an active beneficiary choice of primary care physician with an enrollment fee would make the idea easier to implement and provide an incentive and the financing for elements of service not covered by procedure-based fees.

Diagnosis of Lung Cancer — Improving Survival Rates

Lung cancer is a major global health burden with high incidence rates but poor long-term survival. Currently, the majority of cases are diagnosed at an advanced stage when surgical resection is not feasible. Screening for lung cancer has been a major focus of research for the last 40 years. Despite this, there is still a lack of evidence to promote its use outside clinical trials. More recently, interest has focused on promoting earlier recognition of symptomatic disease among both the general public and primary care physicians in order to encourage more timely investigation and referral to secondary care. The hope is that this approach may increase the proportion of disease identified in the early stages, allowing more surgical resections and improved five-year survival rates. This article provides an overview of the current evidence base in terms of early diagnosis of lung cancer and provides some examples of innovations to promote this.

Best Practices: Integrating Behavioral Health and Primary Care: The Harris County Community Behavioral Health Program

Best Practices: Integrating Behavioral Health and Primary Care: The Harris County Community Behavioral Health Program

Tube Feeding in Advanced Dementia: An Exploratory Survey of Physician Knowledge

The administration of artificial nutrition by means of a percutaneous endoscopic gastrostomy (PEG) tube in older persons in the advanced stages of dementia is commonplace, yet the treatment is associated with significant treatment burdens and unclear benefits in this population. In addition, there is wide and unexplained geographic variability in the use of PEG in advanced dementia, which may stem partly from physicians' lack of understanding about its indications, risks, benefits, and effect on quality of life in advanced dementia. This study was a mail survey undertaken to assess physician knowledge regarding tube feeding in advanced dementia and explore whether certification in geriatrics or other physician characteristics are associated with physician knowledge. To assess knowledge about tube feeding, we asked participants to rate the importance of commonly cited, but non-evidence based, indications for tube feeding in advanced dementia, including recurrent aspiration pneumonia, abnormal swallowing evaluations, abnormal nutritional parameters, preventing an uncomfortable death, and others. Discrepancies between physician knowledge and current evidence regarding tube feeding in advanced dementia were found, indicating a need for improved education ofprimary care physicians in order to ultimately provide better end-of-life care for patients with advanced dementia.