A Mild Dementia Knowledge Transfer Program to improve knowledge and confidence in primary care: an exploratory study

Abstract

Patients with dementia are often unaware of their disease and do not seek medical attention; thus, health care providers must shift to "active detection" to identify at-risk patients early. No previous studies have focused on promoting this shift, so this study evaluates the efficacy of a new program to improve the knowledge and confidence of primary care providers in the early detection, diagnosis, and management of mild dementia. Physicians and nurses (n = 38) were recruited from 14 practices in Ontario, Canada. The Mild Dementia Knowledge Transfer Program was run at each practice. As a Neuroscience Master’s student I demonstrated the cognitive assessment procedures, and recipients assessed remaining patients with my guidance. Assessments included patient interviews using a Data Gathering Form –developed for the Program – to provide informal cognitive assessment, and the Montreal Cognitive Assessment (MoCA) test. The procedures were discussed between assessments to enhance learning. Later, recipients discussed the assessment results with the dementia specialist and myself; diagnoses and initial care plans were formulated collaboratively. Questionnaires measuring knowledge and confidence regarding detection, assessment and care of mild dementia were developed to measure change pre-post and three months after the Program. Linear mixed-effects models analysis with time as fixed effect and intercept as random effect was conducted to test change. Program recipients showed increases in knowledge-confidence score after the program (10.3; P < .001) paralleling increases in both knowledge and confidence sub-scores; there was no decline after three months (P = .83). No differences were observed between medical and nursing staff. The number of assessments done by recipients was positively associated with knowledge-confidence change (P = .01). Most recipients (70%) rated the program as excellent; 65% rated interactivity as the best part, 34% rated time commitment as the worst part, and 91% rated the program as making it easier to detect dementia. Due to the complex nature of dementia, the Program was performance-oriented, specialist-supported, clinic-based, and flexible to the needs of recipients. It showed acceptability and feasibility within primary care, and the results support its’ efficacy to improve primary care providers’ self-rated knowledge and confidence in mild dementia care.