Anders Wimo, MD, PhD, adjunct professor, Center for Alzheimer Research at Karolinska Institutet, Stockholm, Sweden and family physician, the county council of Gävleborg, Sweden. He is the coordinator of the steering committees of the population project Swedish National study on Aging and Care (SNAC) and a member of the Swedish dementia quality assurance register (SveDem). He is currently responsible for RUN 3 (Primary Care) of MOPEAD.
What is Primary Care Based Patient Engagement?
The vast majority of elderly subjects in many countries frequently visit the primary care physicians. However, there is evidence that in the majority of health systems dementia and cognitive impairment are frequently underdiagnosed in primary care settings. This low rate of dementia diagnosis depends on multiple factors. Some of them are related to the primary care physician and structural problems of the health system (time constraints or absence of adequate post-diagnostic support services). Other factors are beliefs and attitude towards early diagnosis benefits or inadequate training programs for primary care physicians in cognitive disorders. Based on previous experiences, some of these difficulties could be overcome through specific training programs for primary care physicians or improving the communication channels between dementia specialists and primary care physicians. MOPEAD primary care based patient engagement strategy (RUN 3 of MOPEAD) will implement cognitive pre-screening campaigns in the primary care setting.
How will Primary Care based patient engagement support MOPEAD’s goals?
To fulfil the basic goals of MOPEAD, three activities will be carried out:
identify individuals with cognitive impairment in the primary care setting
identify individuals at risk of cognitive impairment in the primary care setting
conduct training and awareness programmes among primary care physicians in the five countries participating in the project.
How will this strategy be performed?
The Primary Care Based Patient Engagement strategy will develop campaigns of information and training directed to primary care physicians to increase their level of awareness about AD, memory complaints and cognitive decline. They will provide them with an appropriate theoretical basis to detect individuals with subtle cognitive impairment or high risk of AD.
It is necessary to use well validated, quick, and easy to implement screening tools for the cognitive pre-screening campaigns in the primary care setting in order to detect hidden cognitive impairment. The pre-screening protocol will encompass three different and complementary methodologies: a) neuropsychological screening tools, b) subjective cognitive decline paradigm and c) dementia risk scores.
How will participants be recruited?
The primary care campaign will be implemented in five European countries: Sweden, Slovenia, Spain, Germany and the Netherlands. Each site should assess at least 100 individuals, or the number needed until 33 individuals have been referred for further specialist diagnostic investigations.
The pre-screening protocol should be administered by a primary care physician. Each site will decide its own organization of the campaign, regarding the number of recruitment days or the number of primary care physicians involved.