Clinician-reported Factors Influencing Performance of Cognitive Evaluations in Primary Care
Kyra O'Brien1, Kristin Harkins1, MaryAnne Peifer1, Melanie Kleid1, Cameron Coykendall1, Robert Burke1, Judy Shea1, Jason Karlawish1
1University of Pennsylvania
Objective:
Conduct a pre-implementation assessment of barriers to performing cognitive evaluations in primary care.
Background:
Early diagnosis is crucial to the optimal management of patients with cognitive impairment due to Alzheimer’s disease (AD) and AD-related dementias. Early diagnosis enables access to disease-modifying therapies and timely psychosocial supports. Patients typically first present to the primary care setting with concerns about their cognition, but in this setting dementia is commonly undiagnosed and AD misdiagnosed, and there is variability in how cognitive evaluations are performed. Though there are known barriers to performing cognitive evaluations in primary care, designing an effective intervention to improve cognitive evaluations in a specific care setting requires an understanding of context-specific barriers.
Design/Methods:
Semi-structured interviews were conducted with Penn Medicine primary care clinicians to learn how they evaluate patients’ cognition and factors that impact those evaluations. Interviews were structured using the Consolidated Framework for Implementation Research and incorporated chart-stimulated recall, where clinicians’ own patient encounters were used to stimulate recall of their clinical decision-making.
Results:
Twenty Penn Medicine primary care clinicians were interviewed between September 2022 and January 2023. Primary care clinicians felt that while they have a responsibility to perform cognitive evaluations, they lacked the expertise to perform or interpret them. Barriers to performing cognitive evaluations included the perception they are time intensive and difficult to interpret, the lack of incentives to perform cognitive evaluations, more emphasis on other conditions such as cancer and diabetes, lack of decision-making supports, and limited access to dementia specialists such as neurologists.
Conclusions:
There are modifiable barriers to performing cognitive evaluations in primary care, such as lack of training, incentives, and clinical decision-making supports. This data will inform design of an intervention to improve cognitive evaluations in Penn Medicine primary care practices.