CLINICAL-VARIABLES INFLUENCING TREATMENT DECISIONS FOR AGITATED DEMENTIA PATIENTS - SURVEY OF PHYSICIAN JUDGMENTS

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.