Data_Sheet_1_Educational interventions to improve detection and management of cognitive decline in primary care—An Italian multicenter pragmatic study.PDF

IntroductionTimely detection of cognitive decline in primary care is essential to promote an appropriate care pathway and enhance the benefits of interventions. We present the results of a study aimed to evaluate the effectiveness of an educational intervention addressed to Italian family physicians (FPs) to improve timely detection and management of cognitive decline.
Materials and methodsWe conducted a pre-post study in six Italian health authorities (HAs) involving 254 FPs and 3,736 patients. We measured process and outcome indicators before the intervention (1 January 2014 to 31 December 2016) and after the intervention (1 January 2018 to 31 December 2019). One interactive face-to-face session workshop was delivered by local cognitive disorders and dementia specialists and FP advisors at each HA, in the period September 2017–December 2017. The session focused on key messages of the local Diagnostic and Therapeutic Care Pathway (DTCP) or regional guidelines: (a) the role of the FP for a timely suspicion of cognitive decline is fundamental; (b) when cognitive decline is suspected, the role of the FP is active in the diagnostic work-up; (c) FP’s knowledge on pharmacological and non-pharmacological interventions is essential to improve the management of patients with cognitive decline.
ResultsAn overall improvement in diagnostic procedures and management of patients with cognitive decline by FPs after the intervention was observed. The number of visits per year performed by FPs increased, and the time interval between the first FP consultation and the diagnosis was optimized. Neuroleptic use significantly decreased, whereas the use of benzodiazepines remained steadily high. Non-pharmacological interventions, or use of support services, were underrepresented even in the post-intervention. Differences among the participating HAs were identified and discussed.
DiscussionResults from this study suggest the success of the educational intervention addressed to FPs in improving early detection and management of cognitive decline, highlighting the importance to continue medical education in this field. At the same time, further initiatives of care pathway dissemination and implementation should promote strategies to enhance interactions between primary and secondary care optimizing the collaboration between FPs and specialists.

引言
在基层医疗场景中及时识别认知衰退，对于优化合理诊疗路径、提升干预措施的获益效果至关重要。本研究旨在评估针对意大利家庭医生（family physicians, FPs）的教育干预方案对改善认知衰退及时识别与管理的效果，现将研究结果呈现如下。

材料与方法
本研究在6个意大利卫生主管部门（health authorities, HAs）开展一项前后对照研究，共纳入254名家庭医生及3736名患者。研究分别在干预前（2014年1月1日至2016年12月31日）与干预后（2018年1月1日至2019年12月31日）两个阶段采集过程指标与结局指标。2017年9月至12月期间，各卫生主管部门均由当地认知障碍与痴呆专科医师及家庭医学顾问开展1次交互式面对面专题研讨会。本次研讨会聚焦当地《诊断治疗护理路径（Diagnostic and Therapeutic Care Pathway, DTCP）》或区域指南的核心要点：（1）家庭医生及时疑似认知衰退的作用至关重要；（2）当疑似认知衰退时，家庭医生应积极参与诊断检查流程；（3）家庭医生掌握药物与非药物干预手段的知识，对优化认知衰退患者的管理至关重要。

结果
干预后，家庭医生在认知衰退患者的诊断流程与管理方面整体得到改善。家庭医生年度接诊量有所提升，且首次家庭医生咨询至确诊的时间间隔得到优化。抗精神病药物使用量显著下降，但苯二氮䓬类药物的使用仍维持在较高水平。即便在干预后阶段，非药物干预手段或支持服务的应用仍不足。本研究同时分析并讨论了各参与卫生主管部门之间的差异。

讨论
本研究结果表明，针对家庭医生开展的教育干预方案在改善认知衰退早期识别与管理方面取得了成效，凸显了持续开展该领域医学教育的重要性。同时，未来应进一步推进诊疗路径的推广与落地工作，制定策略加强基层医疗与二级医疗的联动，优化家庭医生与专科医师之间的协作模式。