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The Effects of Computerized Cognitive Testing of Older Patients on Primary Care Physicians' Approaches to Care: A
Mary C Tierney1, Jocelyn Charles, Gary Naglie
1Departments of *Family & Community Medicine ∥Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto †Primary Care Research Unit, Sunnybrook Health Sciences Centre ¶Primary Care and Population Health, Institute for Clinical Evaluative Sciences ‡Department of Medicine and Rotman Research Institute, Baycrest Health Sciences §Research Department, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
Background:
We evaluated effects of providing primary care physicians (PCPs) with reports of their patients' results on the Computer Assessment of Mild Cognitive Impairment (CAMCI) by examining their documented care approaches after receipt of the report.
Methods:
Patients were 65 years and above, without a diagnosis or previous workup for dementia, seen consecutively over 2 months by one of 13 PCPs. PCPs indicated whether they, patients, or families had concerns about patients' cognition. A total of 259 patients individually completed the CAMCI and results were provided to the PCP. Two raters blind to CAMCI results recorded care approaches documented by PCPs at the first visit within 3 months of report (n=181).
Results:
In total, 28 different care approaches were grouped as related to Cognition or Safety/Self-Care. Negative binomial regression revealed that the number of care approaches was significantly associated with performance on the CAMCI for both Cognition and Safety/Self-care domains. These findings remained significant when covariates included PCPs' cognitive concern before CAMCI results, and patients' age, sex, number of comorbidities, and living arrangements.
Conclusions:
Our findings indicate that PCPs documented more care approaches in patients with greater cognitive impairment based on the CAMCI results and this was independent of their, the patients', or families' prior concerns about their patients' cognition.
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