Cc. Colenda et al., CLINICAL-VARIABLES INFLUENCING TREATMENT DECISIONS FOR AGITATED DEMENTIA PATIENTS - SURVEY OF PHYSICIAN JUDGMENTS, Journal of the American Geriatrics Society, 44(11), 1996, pp. 1375-1379
OBJECTIVE: To better understand primary treatment recommendations and
the variables that might influence treatment decisions of physicians w
ho treat agitated dementia patients. DESIGN: A written cross-sectional
survey of three physician groups (geriatric psychiatrists, primary ca
re physicians, and neurologists) who typically treat agitated dementia
patients in community settings. We used a written clinical vignette d
escribing a home-bound, agitated dementia patient to ask respondents t
o provide information regarding their primary treatment recommendation
and to estimate the degree to which clinically relevant variables mig
ht influence their treatment recommendation. Using principal component
analysis, the original set of clinical variables was collapsed into a
smaller set of composite factors that better defined the fundamental
constructs of the variables that influenced decision making. Analyses
compared primary treatment recommendations and factors influencing tre
atment recommendations by physician groups. PARTICIPANTS: The pool of
survey respondents consisted of a random selection of 207 primary care
physicians from western North Carolina, 147 geriatric psychiatrists o
btained from the roster of the 1391 American Association for Geriatric
Psychiatry, and 120 neurologists obtained from the roster of the Amer
ican Board of Medical Specialties. The response rate was 65% for geria
tric psychiatrists, 38% for primary care physicians, and 33% for neuro
logists. RESULTS: Differences in primary treatment recommendations by
physician group were not found. Physicians, regardless of specialty, r
ecommended neuroleptic medications as their primary intervention. When
medication classes were collapsed into a single category, medications
as a primary intervention exceeded 55% for all physician groups. Twen
ty-two percent of all respondents recommended psychosocial interventio
ns as primary treatment strategies. The principal component analysis o
f clinical variables influencing treatment recommendations solved for
five components that accounted for 64% of the variance. Comparing the
five components by specialty groups failed to find significant differe
nces, except for Factor 5, the ''Hassle Factor.'' Primary care physici
ans were more likely to indicate that this component influenced their
decision making than were the other physician groups. CONCLUSIONS: The
findings indicate that physicians, regardless of specialty, are likel
y to use medication and to weight clinically relevant information in a
similar fashion when managing agitated dementia patients.