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Primary care practitioners (PCPs) are the first point of contact for most patients with suspected dementia and have identified a need for more training and support around dementia diagnosis and care. This qualitative study examined the Alzheimer's Disease–Extension for Community Healthcare Outcomes (AD-ECHO) program. AD-ECHO was designed to strengthen PCP capacity in dementia through bimonthly virtual meetings with a team of dementia experts. We conducted 24 hr of direct observations at AD-ECHO sessions and interviewed 14 participants about their experiences participating. Using thematic analysis, we found that participants valued the supportive learning environment and resources; knowledge gained empowered them to take more action around dementia; they identified ways of disseminating knowledge gained into their practice settings, and many desired ongoing AD-ECHO engagement. However, most identified time as a barrier to participation. AD-ECHO has the potential to strengthen the primary care workforce's knowledge and confidence around dementia care. [ABSTRACT FROM AUTHOR]

Background: Dementia is frequently underdiagnosed or misdiagnosed in primary care, where most patients are initially seen. In 2018, in response to California State Bill 833, the ten California Alzheimer's Disease Centers (CADCs) developed an instrument, the Assessment of Cognitive Complaints Toolkit for AD (ACCT‐AD), to guide primary care providers (PCPs) through the dementia diagnostic process. We examine how a stakeholder‐informed process shaped the development of the ACCT‐AD toolkit. Method: Our implementation study involved a two‐phase process. In Phase 1, experts from the CADCs provided consensus input to design the toolkit. We then conducted three focus groups with primary care providers to get feedback on toolkit design and workflow. Changes were made based on feedback. In Phase Two, we conducted 10 feedback sessions with providers who used or reviewed the toolkit and 124 surveys about experiences using the toolkit. Result: The toolkit: The toolkit offers step‐by‐step instruction on how to collect information for a dementia diagnosis, including a series of questions, identified by CADC committee consensus. Each question is followed by examples of typical concerns. The toolkit interprets answers commonly encountered, indicating which are indicative of normal aging, Alzheimer's disease (AD), or a non‐AD dementia. Focus groups: PCPs reported lack of systematic approach to diagnosing dementia and time constraints. They found the toolkit valuable as an educational tool but were concerned about length. They suggested modifications: a self‐administered questionnaire, streamline answer tracking, and electronic health record (EHR) integration. A major concern was how to identify patients who have Mild Cognitive Impairment (MCI). The team addressed all PCP concerns. Surveys, 66 providers found the toolkit extremely useful in identifying a probable diagnosis, 55 found it somewhat useful, 3 did not find it to be useful. Conclusion: Engagement of stakeholders in the design and improvement of a dementia diagnosis toolkit is critical for improving its feasibility and usability for clinical practice. The ACCT‐AD toolkit is part of a larger vision to create a network of dementia‐proficient community practices connected to the CADC system. As potential treatments for AD and options for diagnostic testing evolve, this network can serve as a resource for disseminating knowledge. [ABSTRACT FROM AUTHOR]

Background: A diagnosis of dementia impacts all other comorbid conditions and areas of patient care. Yet, in primary care settings, dementia is often underdiagnosed and misdiagnosed due to competing clinical concerns. Delayed diagnosis and care of dementia can lead to more rapid cognitive decline, and increased hospitalizations, health care costs, and mortality. The objective of this work was to understand the challenges and successful approaches among primary care providers working in safety net settings when caring for patients with dementia and co‐existing chronic conditions. Methods: Qualitative interviews focused on practices and challenges diagnosing and caring for patients with dementia, challenges related to comorbidities, needs for practice improvement, and successful approaches. Data was analyzed using thematic analysis. Results: We interviewed primary care physicians (n = 29) and primary care nurse practitioners (n = 6) based in California safety net settings in the SF Bay Area, Central Valley, and Southern California. PCPs identified the following comorbidities as most challenging to co‐manage with dementia: mental illness (depression/anxiety), hypertension, diabetes, heart disease, stroke, pain, substance use, and trauma. Most PCPs made a distinction between poorly controlled and well‐controlled chronic conditions. Challenges identified included: difficulty differentiating symptoms of dementia from other conditions, medication management and adherence; time constraints when making decisions about prioritizing acute comorbidities or dementia; need for family/caregiver involvement; and challenges controlling comorbid conditions when dementia is present. Successful approaches included: using team‐based care and targeted referrals (e.g. social work, community health workers, geriatrics); the importance of familiarity and long‐term relationships with patients; finding ways to involve family members; and simplifying visits, care plans, and communication. Conclusion: PCPs face difficulties when providing care to patients with dementia and comorbid conditions, but they also identified opportunities for improvement by sharing successful approaches used in challenging healthcare settings. Findings can help shape intervention development to better support PCPs. [ABSTRACT FROM AUTHOR]