Knowledge, attitudes, and practice of general practitioners toward community detection and management of mild cognitive impairment: a cross-sectional study in Shanghai, China

Yuan Lü1, George Liu2, Sally Fawkes2, Zhaoxin Wang3, Dehua Yu4
1Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
2School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
3School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
4Tongji University School of Medicine, Shanghai, 200092, China

Tóm tắt

AbstractBackground

General practitioners (GPs) are in a unique position for community detection and management of mild cognitive impairment (MCI). However, adequate knowledge, attitudes, and practice (KAP) are prerequisites for fulfilling such a role. This study aims to assess the MCI-related KAP of GPs in Shanghai, China.

Methods

An online survey was conducted on 1253 GPs who were recruited from 56 community health centres (CHCs) in Shanghai between April and May 2021. Knowledge (8 items), attitudes (13 items), and practice (11 items) were assessed using a scale endorsed by a panel of multidisciplinary experts. An average summed score was calculated and transformed into a score ranging from 0 to 100 for knowledge, attitudes, and practice, respectively. Adjusted odds ratios (AORs) were calculated for potential predictors of higher levels of KAP scores (with mean value as a cutoff point) through logistic modelling. The mediating role of attitudes on the association between knowledge and practice was tested using the PROCESS model 4 macro with 5000 bootstrap samples through linear regression modelling.

Results

A total of 1253 GPs completed the questionnaire, with an average score of 54.51 ± 18.18, 57.31 ± 7.43, and 50.05 ± 19.80 for knowledge, attitudes, and practice, respectively. More than 12% of respondents scored zero in knowledge, 28.4% tended not to consider MCI as a disease, and 19.1% completely rejected MCI screening. Higher levels of knowledge were associated with more favourable attitudes toward community management of MCI (AOR = 1.974,p < 0.001). Higher compliance with practice guidelines was associated with both higher levels of knowledge (AOR = 1.426,p < 0.01) and more favourable attitudes (AOR = 2.095,p < 0.001). The association between knowledge and practice was partially mediated by attitudes (p < 0.001). Training was associated with higher levels of knowledge (AOR = 1.553,p < 0.01), while past experience in MCI management was associated with more favourable attitudes (AOR = 1.582,p < 0.05) and higher compliance with practice guidelines (AOR = 3.034,p < 0.001). MCI screening qualification was associated with higher compliance with practice guidelines (AOR = 2.162,p < 0.05), but less favourable attitudes (AOR = 0.452,p < 0.05).

Conclusion

The MCI knowledge of GPs in Shanghai is low, and is associated with less favourable attitudes toward MCI management and low compliance with practice guidelines. Attitudes mediate the association between knowledge and practice. Training is a significant predictor of knowledge. Further studies are needed to better understand how the attitudes of GPs in Shanghai are shaped by the environments in which they live and work.

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Tài liệu tham khảo

Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, et al. Mild cognitive impairment - Beyond controversies, towards a consensus: Report of the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004;256(3):240–6.

Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673–734.

Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413–46.

Langa KM, Levine DA. The diagnosis and management of mild cognitive impairment: a clinical review. JAMA. 2014;312(23):2551–61.

Quentin W, Riedel-Heller S, Luppa M, Rudolph A, König HHJAPS. Cost-of-illness studies of dementia: a systematic review focusing on stage dependency of costs. Acta Psychiat Scand. 2010;121(4):243–59.

Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST. Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review) - Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56(9):1133–42.

Gjøra L, Strand BH, Bergh S, Borza T, Brækhus A, Engedal K, et al. Current and future prevalence estimates of mild cognitive impairment, dementia, and its subtypes in a population-based sample of people 70 years and older in Norway: The HUNT study. J Alzheimers Dis. 2021;79(3):1213–26.

James T, Mukadam N, Sommerlad A, Guerra Ceballos S, Livingston G. Culturally tailored therapeutic interventions for people affected by dementia: a systematic review and new conceptual model. Lancet Healthy Longevity. 2021;2(3):e171–9.

Lautenschlager NT, Cox K, Kurz AF. Physical activity and mild cognitive impairment and Alzheimer’s disease. Curr Neurol Neurosci Rep. 2010;10(5):352–8.

Ismail Z, Elbayoumi H, Fischer CE, Hogan DB, Millikin CP, Schweizer T, et al. Prevalence of Depression in Patients With Mild Cognitive Impairment: A Systematic Review and Meta-analysis. JAMA Psychiat. 2017;74(1):58–67.

Cooper C, Sommerlad A, Lyketsos CG, Livingston G. Modifiable predictors of dementia in mild cognitive impairment: a systematic review and meta-analysis. J Am Acad Psychiatry. 2015;172(4):323–34.

Ackley SF, Zimmerman SC, Brenowitz WD, Tchetgen EJT, Gold AL, Manly JJ. Effect of reductions in amyloid levels on cognitive change in randomized trials: instrumental variable meta-analysis. BMJ. 2021;372:N156.

Zhang L, Zhao Y, Shen C, Lei L, Dong J, Zou D, et al. Can long-term regular practice of physical exercises including taichi improve finger tapping of patients presenting with mild cognitive impairment? Front Physiol. 2018;9:1396.

Singh B, Parsaik AK, Mielke MM, Erwin PJ, Knopman DS, Petersen RC, et al. Association of mediterranean diet with mild cognitive impairment and Alzheimer’s disease: a systematic review and meta-analysis. J Alzheimers Dis. 2014;39(2):271–82.

Xu B, Sui Y, Zhu C, Yang X, Zhou J, Li L, et al. Music intervention on cognitive dysfunction in healthy older adults: a systematic review and meta-analysis. Neurol Sci. 2017;38(6):983–92.

Leung P, Orrell M, Orgeta V. Social support group interventions in people with dementia and mild cognitive impairment: a systematic review of the literature. Int J Geriatr Psych. 2015;30(1):1–9.

Sherman DS, Mauser J, Nuno M DS. The efficacy of cognitive intervention in mild cognitive impairment (mci): a meta-analysis of outcomes on neuropsychological measures. Neuropsychol Rev. 2017;27(4):440–84.

Moro V, Condoleo M, Sala F, Pernigo S, Moretto G, Gambina G. Cognitive stimulation in a-MCI: an experimental study. Am J Alzheimers Dis. 2012;27(2):121–30.

Willis SL, Tennstedt SL, Marsiske M, Ball K, Elias J. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA. 2006;296(23):2805–14.

Bahar-Fuchs A, Clare L, Woods B. Cognitive training and cognitive rehabilitation for persons with mild to moderate dementia of the Alzheimer’s or vascular type: a review. Alzheimers Res Ther. 2013;5:35.

Hafdi M, Hoevenaar-Blom MP, Richard E. Multi-domain interventions for the prevention of dementia and cognitive decline. Cochrane Database Syst Rev. 2021;11:CD013572-CD.

Sabbagh MN, Boada M, Borson S, Chilukuri M, Dubois B, Ingram J, et al. Early Detection of mild cognitive impairment (mci) in primary care. J Prev Alzheimers Dis. 2020;7(3):165–70.

Allan CL, Behrman S, Ebmeier KP, Valkanova V. Diagnosing early cognitive decline-When, how and for whom? Maturitas. 2017;96:103–8.

French S, Green S, O’Connor D, McKenzie J, Francis J, Michie S, et al. Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the theoretical domains framework. Implement Sci. 2012;7:38.

Klöckner CA. A comprehensive model of the psychology of environmental behaviour—a meta-analysis. Global Environl Chang. 2013;23(5):1028–38.

WHO. Advocacy, Communication and Social Mobilization for TB Control: A Guide to Developing Knowledge, Attitude and Practice Surveys. Geneva, Switzerland: World Health Organization; 2008.

Perkins MB, Jensen PS, Jaccard J, Gollwitzer P, Oettingen G, Pappadopulos E, et al. Applying theory-driven approaches to understanding and modifying clinicians’ behavior: What do we know? Psychiatr Serv. 2007;58:342–8.

Armitage C, Conner M. Efficacy of the Theory of Planned Behaviour: a meta-analytic review. Br J Soc Psychol. 2001;40:471–99.

Werner P, Heinik J, Kitai E. Familiarity, knowledge, and preferences of family physicians regarding mild cognitive impairment. Int Psychogeriatr. 2013;25(5):805–13.

Serrano CM, Allegri RF, Caramelli P, Taragano FE, Camera L. Mild cognitive impairment. Survey of attitudes of specialists and general physicians. Medicina. 2007;67(1):19–25.

Sannemann L, Müller T, Waterink L, Zwan M, Wimo A, Stomrud E, et al. General practitioners’ attitude toward early and pre-dementia diagnosis of AD in five European countries-A MOPEAD project survey. Alzheimers Dement (Amst). 2021;13(1):e12130.

Koch T, Iliffe S. Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: A systematic review. BMC Fam Pract. 2010;11:52.

Davneet J, Jenna R, Rezaul K, Baishali A, Black CM. Physician Perceptions about the Barriers to Prompt Diagnosis of Mild Cognitive Impairment and Alzheimer’s Disease. Int J Alzheimers. 2019;2019:3637954.

Hanzevacki M, Ozegovic G, Simovic I, Bajic Z. Proactive approach in detecting elderly subjects with cognitive decline in general practitioners’ practices. Dement ger cogn D ex. 2011;1(1):93–102.

Kaduszkiewicz H, Zimmermann T, Van den Bussche H, Bachmann C, Wiese B, Bickel H, et al. Do general practitioners recognize mild cognitive impairment in their patients? J nutr health aging. 2010;14(8):697–702.

Judge D, Roberts J, Khandker RK, Ambegaonkar B, Black CM. Physician practice patterns associated with diagnostic evaluation of patients with suspected mild cognitive impairment and alzheimer’s disease. Int J Alzheimers Dis. 2019;2019:4942562.

Mitchell AJ, Meader N, Pentzek M. Clinical recognition of dementia and cognitive impairment in primary care: a meta-analysis of physician accuracy. Acta Psychiatr Scand. 2011;124(3):165–83.

Yip W, Fu H, Chen AT, Zhai T, Jian W, Xu R, et al. 10 years of health-care reform in China: progress and gaps in universal health coverage. Lancet. 2019;394:1192–204.

Cheng J-M, Yuan Y-X, Lu W, Yang L. Primary health care in China: is China’s health reform reform for the whole nation? Prim Health Care Res Dev. 2017;18(4):398–403.

Shanghai Municipal Health Comission. Monitoring statistis on Shanghai elderly population and elderly development programs. Available at: http://wsjkw.sh.gov.cn/tjsj2/20200527/06873e6ec8f54a158c25475dbbb574a6.html; (Accessed on 06/5/2021)

Shi J, Jin H, Shi L, Chen C, Ge X, Lu Y, et al. The quality of primary care in community health centers: comparison among urban, suburban and rural users in Shanghai, China. BMC Fam Pract. 2020;21(1):178.

Xu J, Wang J, Wimo A, Fratiglioni L, Qiu C. The economic burden of dementia in China, 1990–2030: implications for health policy. Bull World Health Organ. 2017;95(1):18–26.

Lu Y, Liu C, Yu D, Fawkes S, Ma J, Zhang M, et al. Prevalence of mild cognitive impairment in community-dwelling Chinese populations aged over 55 years: a meta-analysis and systematic review. BMC Geriatr. 2021;21(1):10.

Shanghai Civil Affairs Bureau. The construction of friendly communities for the elderly with cognitive impairment. Available at: https://mzj.sh.gov.cn/MZ_zhuzhan279_0-2-8-15-55-231/20201020/871c380077834e93b711974059705902.html; (Accessed on 06/5/2021)

Hou J, Michaud C, Li Z, Dong Z, Sun B, Zhang J, et al. Transformation of the education of health professionals in China: progress and challenges. Lancet. 2014;384(9945):819–27.

Imre N, Balogh R, Papp E, Kovacs I, Heim S, Karadi K, et al. Knowledge of general practitioners on dementia and mild cognitive impairment: a cross-sectional, questionnaire study from Hungary. Educ Gerontol. 2019;45(8):495–505.

Stadler M, Sailer M, Fischer F. Knowledge as a formative construct: A good alpha is not always better. New Ideas Psychol. 2021;60:100832.

Collier JE, Bienstock CC. Model Misspecification: Contrasting Formative and Reflective Indicators for a Model of E-Service Quality. J Market Theory Prac. 2014;17(3):283–93.

Freund RJ, WJ W. Regression Analysis: Statistical Modeling of a Response Variable. Second edition.. ed. New York, New York London, England: The Guilford Press; 1998.

Annear MJ, Toye CM, Eccleston CE, McInerney FJ, Elliott KEJ, Tranter BK, et al. Dementia knowledge assessment scale: development and preliminary psychometric properties. The Am Geriatr Soc. 2015;63(11):2375–81.

Mason RL, Annear MJ, Lo A, McInerney F, Tierney LT, Robinson A. Development and preliminary psychometric properties of the General Practitioner Attitudes and Confidence Scale (GPACS–D) for dementia. BMC Fam Pract. 2016;17(1):105.

Caruana-Pulpan O, Scerri C. Practices in diagnosis, disclosure and pharmacotherapeutic management of dementia by general practitioners - A national survey. Aging and Ment Health. 2014;18(2):179–86.

Wang M, Xu X, Huang Y, Shao S, Chen X, Li J, et al. Knowledge, attitudes and skills of dementia care in general practice: a cross-sectional study in primary health settings in Beijing, China. BMC Fam Pract. 2020;21(1):89.

Carpenter BD, Zoller SM, Balsis S, Otilingam PG, Gatz M. Demographic and contextual factors related to knowledge about Alzheimer’s disease. Am J Alzheimers Dis. 2011;26(2):121–6.

Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed inform. 2019;95: 103208.

Bolin JH. Book Review - Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. Journal of Educational Measurement: Blackwell Publishing Ltd; 2014. p. 335–7.

Shanghai Statistics Bureau. Shanghai statistical yearbook 2020. Available at: https://www.yearbookchina.com/naviBooklist-n3020013183-1.html; (Accessed on 06/5/2021)

Ahmad S, Orrell M, Iliffe S, Gracie A. GPs’ attitudes, awareness, and practice regarding early diagnosis of dementia. Br J Gen Pract. 2010;60(578):e360–5.

Pathak KP, Montgomery A. General practitioners’ knowledge, practices, and obstacles in the diagnosis and management of dementia. Aging Ment Health. 2015;19(10):912–20.

Veneziani F, Panza F, Solfrizzi V, Capozzo R, Barulli MR, Leo A, et al. Examination of level of knowledge in Italian general practitioners attending an education session on diagnosis and management of the early stage of Alzheimer’s disease: Pass or fail? Int Psychogeriatr. 2016;28(7):1111–24.

Matyas N, Auer S, Gisinger C, Kil M, Aschenberger FK, Klerings I, et al. Continuing education for the prevention of mild cognitive impairment and Alzheimer’s-type dementia: a systematic review protocol. J Syst Rev BMJ Open. 2019;9:e027719. https://doi.org/10.1136/bmjopen-2018-027719.

Mitchell T, Woodward M, Hirose Y. A survey of attitudes of clinicians towards the diagnosis and treatment of mild cognitive impairment in Australia and New Zealand. Int Psychogeriatr. 2008;20(1):77–85.

Tong T, Thokala P, McMillan B, Ghosh R, Brazier J. Cost effectiveness of using cognitive screening tests for detecting dementia and mild cognitive impairment in primary care. Int J Geriatr Psych. 2017;32(12):1392–400.

Harmand MGC, Meillon C, Rullier L, Taddé OB, Pimouguet C, Dartigues JF, et al. Description of general practitioners’ practices when suspecting cognitive impairment. Recourse to care in dementia (Recaredem) study. Aging and Ment Health. 2018;22(8):1040–9.

Subramaniam M, Ong HL, Abdin E, Chua BY, Shafie S, Siva Kumar F, et al. General Practitioner’s attitudes and confidence in managing patients with dementia in Singapore. J Ann Acad med Singapore. 2018;47:108–18.

Godin G, Belanger-Gravel A, Eccles M, Grimshaw J. Healthcare professionals’ intentions and behaviours: a systematic review of studies based on social cognitive theories. Implement Sci. 2008;3:36.

Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud P-AC, et al. Why Don’t Physicians Follow Clinical Practice Guidelines? A Framework for Improvement. JAMA. 1999;282(15):1458–65.

Yang L, Liu C, Ferrier JA, Zhang X. Organizational barriers associated with the implementation of national essential medicines policy: a cross-sectional study of township hospitals in China. Soc Sci Med. 2015;145:201–8.

Liu C, Bartram T, Leggat SG. Link of patient care outcome to occupational differences in response to human resource management: a cross-sectional comparative study on hospital doctors and nurses in China. Int J Env Res Pub He. 2020;17(12):4379.

Turner S, Iliffe S, Downs M, Wilcock J, Bryans M, Levin E, et al. General practitioners’ knowledge, confidence and attitudes in the diagnosis and management of dementia. Age Ageing. 2004;33(5):461–7.

Perry M, Drašković I, Lucassen P, Vernooij-Dassen M, van Achterberg T, Rikkert MO. Effects of educational interventions on primary dementia care: a systematic review. Int J Geriat Psychiatry. 2011;26(1):1–11.

Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving Chronic Illness Care: Translating Evidence Into Action. Health Aff. 2001;20(6):64–78.

Lai SH, Tsoi T, Tang CT, Hui RJY, Tan KK, Yeo YWS, et al. An integrated, collaborative healthcare model for the early diagnosis and management of dementia: Preliminary audit results from the first transdisciplinary service integrating family medicine and geriatric psychiatry services to the heart of patients’ homes. BMC Psychiatr. 2019;19:61.