Adherence to Clinical Practice Guidelines during Dementia Work-Up in a Real-World Setting: A Study from the Registry of Dementias of Girona

Article type: Research Article

Authors: Turró-Garriga, Oriol^{a; b} | Calvó-Perxas, Laia^{a; *} | Vilalta-Franch, Joan^{a; b; c} | Hernández-Ferrándiz, Marta^b | Flaqué, Margarita^d | Linares, Marta^e | Cullell, Marta^f | Gich, Jordi^g | Casas, Isabel^h | Perkal, Héctorⁱ | Garre-Olmo, Josep^{a; b; c} | on behalf of the Registry of Dementia of Girona Study Group (ReDeGi Study Group)

Affiliations: [a] Girona Biomedical Research Institute (IDIBGI), Salt, Girona, Spain | [b] Dementia Unit, Hospital de Santa Caterina, Salt, Catalonia, Spain | [c] Department of Medicine, University of Girona, Spain | [d] Dementia Unit, Hospital de Palamós, Palamós, Girona, Spain | [e] Department of Neurology, Hospital d’Olot, Olot, Spain | [f] Neurology Unit, Hospital de Figueres, Figueres, Spain | [g] Neurodegenerative Disease Unit, Hospital Universitari Dr. Josep Trueta, Girona, Spain | [h] Department of Neurology, Hospital de Campdevánol, Campdevánol, Spain | [i] Department of Geriatrics and Neurology, Hospital de Blanes, Blanes, Spain

Correspondence: [*] Correspondence to: Laia Calvó-Perxas, Girona Biomedical Research Institute (IdIBGI), C/Dr. Castany, s/n, 17190 Salt (Girona), Catalonia, Spain. Tel.: +34 972 18 26 00/Ext. 1832; E-mail: [email protected].

Abstract: Background:There are several position statements and clinical practice guidelines (CPG) for diagnosing dementia. Objective:Our aims were to evaluate the adherence to CPG among specialists in the 7 memory clinics included in the Registry of Dementias of Girona (ReDeGi), and to compare the results between 2007–2011 and 2012–2015. We also determined the time and number of visits required to achieve a diagnosis, the supplementary tests ordered, and the drugs prescribed according to dementia subtypes. Methods:Medical charts of a stratified random sample of 475 ReDeGi cases were reviewed. Basic dementia work-up was evaluated using as a reference evidence-based CPG. An Index of Adherence (AI) was calculated using the following items in the medical chart: cognitive symptomatology; functional disability evaluation; physical examination; neurological examination; psychiatric examination; brief cognitive examination; activities of daily living performance examination; blood test; structural neuroimaging (CT-scan or MRI). Results:The mean AI to CPG among specialists was of 8.2 points, and it improved from 7.9 points in 2007–2011 to 8.5 points in 2012–2015 (Cohen’s d = 0.46). A lower adherence was detected in the most severe cases. A dementia diagnosis required 3.5 visits, regardless of the subtype of dementia, although milder cases required more time, more visits, and more supplementary tests than severe cases. Conclusion:The adherence to CPG in the catchment area of the ReDeGi is high, and an epidemiological surveillance system such as the ReDeGi may help in improving it. Dementia guidelines should establish procedures adapted to clinical practice, with simplified recommendations for most severe cases.

Keywords: Dementia, diagnosis, practice guideline, registries

DOI: 10.3233/JAD-170284

Journal: Journal of Alzheimer's Disease, vol. 59, no. 3, pp. 997-1007, 2017