Mixed-effects model results for patients aged 75 years or more with neurocognitive disorders before and after implementation of the Quebec Alzheimer Plan*
| Variable | No. (%) of patients† | Adjusted mean difference (95% Cl) | ICC | |
|---|---|---|---|---|
| Before n = 455 | After n = 490 | |||
| No. of contacts with Family Medicine Group, mean ± SD | 7.9 ± 10.2 | 9.9 ± 9.7 | 1.57 (0.30–2.84) | 0.12 |
| Quality of follow-up score, mean ± SD | 48.0 ± 20.0 | 54.6 ± 18.8 | 6.58 (3.92–9.23) | 0.08 |
| Cognitive testing‡ | 226 (50.1) n = 451 | 239 (49.2) n = 486 | – | – |
| Evaluation of functional status | 317 (69.7) | 397 (81.0) | – | – |
| Evaluation of behavioural and psychological symptoms of dementia | 318 (69.9) | 398 (81.2) | – | – |
| Evaluation of weightठ| 265 (59.3) n = 447 | 346 (70.9) n = 488 | Р| Р|
| Evaluation of caregiver needs¶ | 107 (24.0) n = 445 | 133 (28.0) n = 475 | – | – |
| Documentation of driving status¶ | 52 (13.1) n = 398 | 98 (23.7) n = 414 | – | – |
| No anticholinergic medication | 385 (84.6) | 396 (80.8) | – | – |
| Evaluation of home-based service needs | 237 (52.1) | 294 (60.0) | – | – |
| Evaluation of community service needs | 8 (1.8) | 33 (6.7) | – | – |
| Management of dementia medications (memantine and cholinesterase inhibitors)** | 94 (54.3) n = 173 | 105 (66.9) n = 157 | – | – |
| OR (95% Cl) | ||||
| Antipsychotic medication | 117 (25.7) | 98 (20.0) | 0.66 (0.47–0.95) | 0.04 |
| Memantine or cholinesterase inhibitors prescribed by Family Medicine Group†† | 27 (71.0) n = 38 | 26 (72.2) n = 36 | 0.81 (0.23–2.81) | 0.01 |
| Referral to memory clinic after diagnosis‡‡ | 40 (11.8) n = 338 | 29 (8.5) n = 340 | 0.66 (0.37–1.16) | 0.001 |
| Justified referral§§¶¶ | 31 (77.5) | 27 (93.1) | – | – |
| Uncertainty | 14 (45.2) | 16 (59.3) | – | – |
| Family request | 4 (12.9) | 6 (22.2) | – | – |
| Presence of depression | 2 (6.4) | 3 (11.1) | – | – |
| Complex medication management | 4 (12.9) | 0 (0.0) | – | – |
| Complex patient management | 11 (35.5) | 10 (37.0) | – | – |
| Other reason§§ | 1 (2.5) | 0 (0.0) | – | – |
| Unjustified referral§§ | 8 (20.0) | 2 (6.9) | – | – |
| No prior evaluation | 4 (50.0) | 1 (50.0) | – | – |
| No justification | 4 (50.0) | 1 (50.0) | – | – |
Note: CI = confidence interval, ICC = intraclass correlation coefficient, OR = odds ratio, SD = standard deviation.
↵* Model estimates adjusted for age, sex and number of medications.
↵† Except where noted otherwise.
↵‡ Excluding patients who refused the evaluation.
↵§ Excluding patients for whom the evaluation was not feasible.
↵¶ Excluding patients for whom the evaluation was not applicable.
↵** Excluding patients who did not take medication or did not had a follow-up visit after the prescription.
↵†† Excluding patients who received their prescription before the study period or did not take medication.
↵‡‡ Excluding patients referred before the study period.
↵§§ Proportions of subgroups.
↵¶¶ There could be more than 1 reason for referral.