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Implementing Routine Cognitive Screening of Older Adults in Primary Care: Process and Impact on Physician Behavior

Journal of General Internal Medicine volume 22, pages 811–817 (2007)Cite this article

An Erratum to this article was published on 31 May 2007

An Erratum to this article was published on 31 May 2007

Abstract

Background

Early detection of cognitive impairment is a goal of high-quality geriatric medical care, but new approaches are needed to reduce rates of missed cases.

Objective

To evaluate whether adding routine cognitive screening to primary care visits for older adults increases rates of dementia diagnosis, specialist referral, or prescribing of antidementia medications.

Setting

Four primary care clinics in a university-affiliated primary care network.

Design

A quality improvement screening project and quasiexperimental comparison of 2 intervention clinics and 2 control clinics. The Mini-Cog was administered by medical assistants to intervention clinic patients aged 65+ years. Rates of dementia diagnoses, referrals, and medication prescribing were tracked over time using computerized administrative data.

Results

Twenty-six medical assistants successfully screened 70% (n = 524) of all eligible patients who made at least 1 clinic visit during the intervention period; 18% screened positive. There were no complaints about workflow interruption. Relative to baseline rates and control clinics, Mini-Cog screening was associated with increased dementia diagnoses, specialist referrals, and prescribing of cognitive enhancing medications. Patients without previous dementia indicators who had a positive Mini-Cog were more likely than all other patients to receive a new dementia diagnosis, specialty referral, or cognitive enhancing medication. However, relevant physician action occurred in only 17% of screen-positive patients. Responses were most related to the lowest Mini-Cog score level (0/5) and advanced age.

Conclusion

Mini-Cog screening by office staff is feasible in primary care practice and has measurable effects on physician behavior. However, new physician action relevant to dementia was likely to occur only when impairment was severe, and additional efforts are needed to help primary care physicians follow up appropriately on information suggesting cognitive impairment in older patients.

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Acknowledgements

This study was funded by an investigator-initiated grant from Ortho McNeil (GAL-ALZ-419). Jürgen Unutzer MD, MPH, made valuable comments on the draft. Sherry Neher assisted with manuscript preparation.

Conflict of Interest

None disclosed.

Author information

Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Campus Box 356560, Seattle, WA, 98195, USA

    Soo Borson MD, James Scanlan PhD, Mary Lessig BS & Elizabeth Zuhr BA

  2. Alzheimer’s Disease Research Center, University of Washington, Seattle, WA, USA

    Soo Borson MD, James Scanlan PhD, Mary Lessig BS & Elizabeth Zuhr BA

  3. University of Washington Physicians Network, University of Washington, Seattle, WA, USA

    Jeffrey Hummel MD, MPH

  4. University of Washington Neighborhood Clinic, University of Washington, Seattle, WA, USA

    Jeffrey Hummel MD, MPH & Kathy Gibbs RN

Authors
  1. Soo Borson MD
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  2. James Scanlan PhD
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  3. Jeffrey Hummel MD, MPH
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  4. Kathy Gibbs RN
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  5. Mary Lessig BS
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  6. Elizabeth Zuhr BA
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Corresponding author

Correspondence to Soo Borson MD.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s11606-007-0242-0

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Borson, S., Scanlan, J., Hummel, J. et al. Implementing Routine Cognitive Screening of Older Adults in Primary Care: Process and Impact on Physician Behavior. J GEN INTERN MED 22, 811–817 (2007). https://doi.org/10.1007/s11606-007-0202-8

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  • DOI: https://doi.org/10.1007/s11606-007-0202-8

KEY WORDS

  • Mini-Cog
  • practice intervention
  • primary care
  • dementia screening
  • clinic intervention