Variation in dementia screening outcomes: the influence of primary care providers' occupations and knowledge, attitudes, skills.

Abstract

Dementia is a growing concern in China. Primary care screening is proposed as a timely and cost-effective way to identify potential cases, while its implementation relies on primary care providers' (PCPs') knowledge, attitudes, and skills. Our study aimed to investigate whether dementia screening outcomes vary according to the PCPs' occupations and how PCPs' knowledge, attitudes, and skills are associated with screening outcomes. A two-stage dementia screening of residents aged 65 years and over in Guangdong, China was conducted using multistage cluster sampling. 252 PCPs, who completed questionnaires, were included in the analysis, along with 2823 older adults screened by them. Screening outcomes included the positive rate of screening, and positive predictive value (PPV). PCPs' knowledge was assessed by the Dementia Knowledge Assessment Scale, attitudes by the Dementia Care Attitudes Scale, and skills by a validated self-designed questionnaire. Multilevel logistic regression was used to assess the associations of PCPs' occupations, knowledge, attitudes, and skills with dementia screening outcomes. Knowledge scores in dementia care differed significantly (P = 0.005) among PCPs of different occupations, while attitudes and skills did not. The positive screening rate had no significant association with PCPs' occupations. Public health physicians (OR = 2.927, 95%CI: 1.091-7.854) and nurses (OR = 3.712, 95%CI: 1.141-12.069) had a higher PPV than general practitioners (GPs). Higher dementia-care skills score (OR = 1.024, 95%CI: 1.004-1.046) was associated with a higher positive rate of screening. Positive attitudes towards dementia care was associated with a lower positive rate of screening (OR = 0.948, 95% CI: 0.905-0.994) and a higher PPV (OR = 1.114, 95% CI: 1.007-1.234). In community settings, involving different occupations of PCPs besides GPs in dementia screening and systematically promoting dementia-care skills training and positive attitudes towards dementia care are important to improve the effectiveness of dementia screening and management.