TY - JOUR
T1 - Applicability of diagnostic recommendations on dementia in family practice
AU - Van Hout, Hein
AU - Vernooij-Dassen, Myrra
AU - Poels, Petra
AU - Hoefnagels, Willibrord
AU - Grol, Richard
N1 - Funding Information: This study was funded by the University of Nijmegen and was not subject to any conflicts of interest. We would like to thank all the family practitioners and patients who participated in this study. Special thanks to Sanne Berkhout, who helped to formulate the expected diagnosis.
PY - 2001
Y1 - 2001
N2 - Objective. To evaluate the applicability of the Dutch dementia guideline's recommendations, including the diagnostic criteria used by family practitioners, and to explore characteristics in both patients and family practitioners which are associated with the use of these recommendations. Design. An observational study was set up with a sample of 64 family practitioners who were instructed to use the Dutch national dementia guideline on incident-suspected dementia patients. The applicability was expressed as the percentage of recommendations applied. The use of diagnostic criteria was checked by comparing the family practitioners diagnoses with the diagnoses received by integrating the registered symptoms according to the DSM-III-R criteria. Associations between the number of recommendations applied, and demographic and clinical features were explored. Main outcome measures. (i) guideline applicability (ii) integrated use of DSM-III-R criteria. Results. 107 patients were included. The average application rate of the guideline's 31 diagnostic key recommendations was 86% or 24.8 (SD 3.6). The family practitioners diagnoses were consistent with the expected DSM-III-R diagnoses in 26% of the cases (κ=0.1). A greater number of patients in a practice was positively associated with the use of recommendations. A need for referral by the family practitioners, and patients' denial of dementia were negatively associated with the use of recommendations. The presence of dementia and a patient's age were negatively associated with the use of the DSM-III-R criteria. Conclusions. The applicability of the diagnostic recommendations of the national Dutch dementia guideline in a representative sample of family practitioners was promising. Nevertheless, the diagnostic criteria of the DSM-III-R, which were part of the dementia guideline, provided little or no guidance to the family practitioners in their diagnostic decision-making. Clinical and demographic variables explained some of the variation in the use of recommendations.
AB - Objective. To evaluate the applicability of the Dutch dementia guideline's recommendations, including the diagnostic criteria used by family practitioners, and to explore characteristics in both patients and family practitioners which are associated with the use of these recommendations. Design. An observational study was set up with a sample of 64 family practitioners who were instructed to use the Dutch national dementia guideline on incident-suspected dementia patients. The applicability was expressed as the percentage of recommendations applied. The use of diagnostic criteria was checked by comparing the family practitioners diagnoses with the diagnoses received by integrating the registered symptoms according to the DSM-III-R criteria. Associations between the number of recommendations applied, and demographic and clinical features were explored. Main outcome measures. (i) guideline applicability (ii) integrated use of DSM-III-R criteria. Results. 107 patients were included. The average application rate of the guideline's 31 diagnostic key recommendations was 86% or 24.8 (SD 3.6). The family practitioners diagnoses were consistent with the expected DSM-III-R diagnoses in 26% of the cases (κ=0.1). A greater number of patients in a practice was positively associated with the use of recommendations. A need for referral by the family practitioners, and patients' denial of dementia were negatively associated with the use of recommendations. The presence of dementia and a patient's age were negatively associated with the use of the DSM-III-R criteria. Conclusions. The applicability of the diagnostic recommendations of the national Dutch dementia guideline in a representative sample of family practitioners was promising. Nevertheless, the diagnostic criteria of the DSM-III-R, which were part of the dementia guideline, provided little or no guidance to the family practitioners in their diagnostic decision-making. Clinical and demographic variables explained some of the variation in the use of recommendations.
KW - Applicability
KW - Dementia
KW - Family practitioner
KW - Guideline
KW - Recommendations
UR - http://www.scopus.com/inward/record.url?scp=0034970191&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/intqhc/13.2.127
DO - https://doi.org/10.1093/intqhc/13.2.127
M3 - Article
C2 - 11430662
SN - 1353-4505
VL - 13
SP - 127
EP - 133
JO - International Journal for Quality in Health Care
JF - International Journal for Quality in Health Care
IS - 2
ER -