TORONTO – Neurologists are more likely than are primary care physicians or psychiatrists to prescribe a cholinesterase inhibitor for a patient with mild to moderate Alzheimer's disease, but even they fall short of meeting goals in clinical guidelines, Daniel L. Murman, M.D., said at the annual meeting of the American Neurological Association.
The ANA's evidence-based guidelines on management of patients with dementia call for physicians caring for ambulatory patients with mild to moderate dementia to consider using a cholinesterase inhibitor where appropriate. A review of real-world data suggests that actual practice falls short of ideal, said Dr. Murman of the University of Nebraska, Omaha.
Dr. Murman and his associates reviewed office visit data that had been collected as part of the National Ambulatory Medical Care Survey of office-based non-federally employed physicians. They focused on office visits made between 1993 and 2001 with the ICD-9 codes 331.0 (Alzheimer's disease), 290.2 (senile dementia with delusion or dementia), and 290.3 (senile dementia with delirium).
Because the patients were ambulatory, it was presumed that their dementia was mild to moderate.
A total of 700,000 office visits were made by the study population for Alzheimer's disease and senile dementia during the years of the study. The investigators extrapolated that there were 7.5 million physician office visits nationwide related to these dementias between 1993 and 2001.
About 34% of the office visits for these categories of dementia were made to internists, 27% were made to family physicians, 12% were made to neurologists, and 11% to psychiatrists. Only 10% of the office visits were by new patients. Overall, 17% of the office visits were by patients referred by other physicians.
On average, physicians spent 34 minutes with a new patient and 20 minutes with an established patient. Neurologists spent the longest time with new patients (40 minutes during that first office visit), compared with 22 minutes for family physicians, 32 minutes for internists, and 37 minutes for psychiatrists. Cholinesterase inhibitors, the only drugs with an indication for Alzheimer's disease, were prescribed for 29% of the patients with Alzheimer's disease. A cholinesterase inhibitor was prescribed in 48% of office visits to neurologists, 29% of those to family physicians, and 27% of those to internists and psychiatrists.