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J Am Med Dir Assoc. 2016 Sep 1;17(9):802-6. doi: 10.1016/j.jamda.2016.04.026. Epub 2016 Jun 11.

Who Is Providing the Predominant Care for Older Adults With Dementia?

Author information

1
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
2
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
3
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD.
4
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Electronic address: Julie.PW.Bynum@dartmouth.edu.

Abstract

OBJECTIVES:

To identify which clinical specialties are most central for care of people with dementia in the community and long-term care (LTC) settings.

DESIGN:

Cross-sectional analysis.

PARTICIPANTS:

Fee-for-service Medicare beneficiaries aged ≥65 years with dementia.

MEASUREMENTS:

Specialty, categorized into primary care (internal or family medicine, geriatrics, or nurse practitioners [NPs]) versus other specialties, of the predominant provider of care (PPC) for each patient, defined by providing the most ambulatory visits.

RESULTS:

Among 2,598,719 beneficiaries with dementia, 74% lived in the community and 80% had a PPC in primary care. In LTC, 91% had primary care as their PPC compared with 77% in the community (P < .001). Cardiology and neurology were the most frequent specialties. NPs were PPCs for 19% of dementia patients in LTC versus 7% in the community (P < .001).

CONCLUSION:

It is unknown whether specialists are aware of their central role for many dementia patients' care needs. In LTC, NPs play the lead role as PPCs.

KEYWORDS:

Medicare; Predominant provider; dementia; long-term care; primary care; specialist

PMID:
27297089
PMCID:
PMC5045870
DOI:
10.1016/j.jamda.2016.04.026
[Indexed for MEDLINE]
Free PMC Article

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