The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice
Clinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse. To ascertain whether a GP's global clinical judgement of future cognitive status has an added value for predicting a patient's likelihood of experiencing de...
Gespeichert in:
| Veröffentlicht in: | British journal of general practice 2019-11, Vol.69 (688), p.e786-e793 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | e793 |
|---|---|
| container_issue | 688 |
| container_start_page | e786 |
| container_title | British journal of general practice |
| container_volume | 69 |
| creator | Pentzek, Michael Wagner, Michael Abholz, Heinz-Harald Bickel, Horst Kaduszkiewicz, Hanna Wiese, Birgitt Weyerer, Siegfried König, Hans-Helmut Scherer, Martin Riedel-Heller, Steffi G Maier, Wolfgang Koppara, Alexander |
| description | Clinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse.
To ascertain whether a GP's global clinical judgement of future cognitive status has an added value for predicting a patient's likelihood of experiencing dementia.
Multicentre prospective cohort study among patients in German general practice that took place from January 2003 to October 2016.
Patients without baseline dementia were assessed with neuropsychological interviews over 12 years; 138 GPs rated the future cognitive decline of their participating patients. Associations of baseline predictors with follow-up incident dementia were analysed with mixed-effects logistic and Cox regression.
A total of 3201 patients were analysed over the study period (mean age = 79.6 years, 65.3% females, 6.7% incident dementia in 3 years, 22.1% incident dementia in 12 years). Descriptive analyses and comparison with other cohorts identified the participants as having frequent and long-lasting doctor-patient relationships and being well known to their GPs. The GP baseline rating of future cognitive decline had significant value for 3-year dementia prediction, independent of cognitive test scores and patient's memory complaints (GP ratings of very mild (odds ratio [OR] 1.97, 95% confidence intervals [95% CI] = 1.28 to 3.04); mild (OR 3.00, 95% CI = 1.90 to 4.76); and moderate/severe decline (OR 5.66, 95% CI = 3.29 to 9.73)). GPs' baseline judgements were significantly associated with patients' 12-year dementia-free survival rates (Mantel-Cox log rank test |
| doi_str_mv | 10.3399/bjgp19X706037 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6783138</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2316415147</sourcerecordid><originalsourceid>FETCH-LOGICAL-c415t-a8f68f7ee7a5388ad0cfa39d01b10842b89f569e7ce31f4bc1ba83d6a1c899723</originalsourceid><addsrcrecordid>eNpVkUFr3DAQhUVpaLZpj70WQQ89OZEs25J6KITQJoVAckihNzGWx14ttuVK8kL-Qn91tUkampMYzTdvHvMI-cDZqRBan7W7YeH6l2QNE_IV2fBKqqIuq_I12TDdsII3lTgmb2PcMVaWDWdvyLHgta6kZBvy526LdA_jitT3NOXi8vZzpHZ0s7Mw0t3aDTjhnKib6RKwcza5eaDdw6eDLxTotI7J2VwGzIiPC2Zmj9T6rQ-JxrR29xQmn8cWSC6D8aA24Iwhr1gC2MP8O3LUwxjx_dN7Qn5-_3Z3cVVc31z-uDi_LmzF61SA6hvVS0QJtVAKOmZ7ELpjvOVMVWWrdF83GqVFwfuqtbwFJboGuFVay1KckK-PusvaTtg9GIfRLMFNEO6NB2dedma3NYPfm0YqwYXKAp-eBIL_vWJMZufXMGfPphT53LzOIWSqeKRsPkkM2D9v4MwcojMvosv8x_9tPdP_shJ_AT1jmRs</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2316415147</pqid></control><display><type>article</type><title>The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice</title><source>MEDLINE</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Pentzek, Michael ; Wagner, Michael ; Abholz, Heinz-Harald ; Bickel, Horst ; Kaduszkiewicz, Hanna ; Wiese, Birgitt ; Weyerer, Siegfried ; König, Hans-Helmut ; Scherer, Martin ; Riedel-Heller, Steffi G ; Maier, Wolfgang ; Koppara, Alexander</creator><creatorcontrib>Pentzek, Michael ; Wagner, Michael ; Abholz, Heinz-Harald ; Bickel, Horst ; Kaduszkiewicz, Hanna ; Wiese, Birgitt ; Weyerer, Siegfried ; König, Hans-Helmut ; Scherer, Martin ; Riedel-Heller, Steffi G ; Maier, Wolfgang ; Koppara, Alexander ; AgeCoDe Study Group ; for the AgeCoDe Study Group</creatorcontrib><description>Clinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse.
To ascertain whether a GP's global clinical judgement of future cognitive status has an added value for predicting a patient's likelihood of experiencing dementia.
Multicentre prospective cohort study among patients in German general practice that took place from January 2003 to October 2016.
Patients without baseline dementia were assessed with neuropsychological interviews over 12 years; 138 GPs rated the future cognitive decline of their participating patients. Associations of baseline predictors with follow-up incident dementia were analysed with mixed-effects logistic and Cox regression.
A total of 3201 patients were analysed over the study period (mean age = 79.6 years, 65.3% females, 6.7% incident dementia in 3 years, 22.1% incident dementia in 12 years). Descriptive analyses and comparison with other cohorts identified the participants as having frequent and long-lasting doctor-patient relationships and being well known to their GPs. The GP baseline rating of future cognitive decline had significant value for 3-year dementia prediction, independent of cognitive test scores and patient's memory complaints (GP ratings of very mild (odds ratio [OR] 1.97, 95% confidence intervals [95% CI] = 1.28 to 3.04); mild (OR 3.00, 95% CI = 1.90 to 4.76); and moderate/severe decline (OR 5.66, 95% CI = 3.29 to 9.73)). GPs' baseline judgements were significantly associated with patients' 12-year dementia-free survival rates (Mantel-Cox log rank test
<0.001).
In this sample of patients in familiar doctor-patient relationships, the GP's clinical judgement holds additional value for predicting dementia, complementing test performance and patients' self-reports. Existing and emerging primary care-based dementia risk models should consider the GP's judgement as one predictor. Results underline the importance of the GP-patient relationship.</description><identifier>ISSN: 0960-1643</identifier><identifier>EISSN: 1478-5242</identifier><identifier>DOI: 10.3399/bjgp19X706037</identifier><identifier>PMID: 31594770</identifier><language>eng</language><publisher>England: Royal College of General Practitioners</publisher><subject>Aged ; Clinical Decision-Making ; Cohort analysis ; Dementia ; Dementia - diagnosis ; Evidence-Based Practice ; Family physicians ; Female ; General Practice ; General Practitioners - standards ; Germany - epidemiology ; Humans ; Judgment ; Male ; Medical diagnosis ; Physician-Patient Relations ; Prospective Studies ; Referral and Consultation - statistics & numerical data</subject><ispartof>British journal of general practice, 2019-11, Vol.69 (688), p.e786-e793</ispartof><rights>British Journal of General Practice 2019.</rights><rights>Copyright Royal College of General Practitioners Nov 2019</rights><rights>British Journal of General Practice 2019 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-a8f68f7ee7a5388ad0cfa39d01b10842b89f569e7ce31f4bc1ba83d6a1c899723</citedby><cites>FETCH-LOGICAL-c415t-a8f68f7ee7a5388ad0cfa39d01b10842b89f569e7ce31f4bc1ba83d6a1c899723</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6783138/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6783138/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31594770$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pentzek, Michael</creatorcontrib><creatorcontrib>Wagner, Michael</creatorcontrib><creatorcontrib>Abholz, Heinz-Harald</creatorcontrib><creatorcontrib>Bickel, Horst</creatorcontrib><creatorcontrib>Kaduszkiewicz, Hanna</creatorcontrib><creatorcontrib>Wiese, Birgitt</creatorcontrib><creatorcontrib>Weyerer, Siegfried</creatorcontrib><creatorcontrib>König, Hans-Helmut</creatorcontrib><creatorcontrib>Scherer, Martin</creatorcontrib><creatorcontrib>Riedel-Heller, Steffi G</creatorcontrib><creatorcontrib>Maier, Wolfgang</creatorcontrib><creatorcontrib>Koppara, Alexander</creatorcontrib><creatorcontrib>AgeCoDe Study Group</creatorcontrib><creatorcontrib>for the AgeCoDe Study Group</creatorcontrib><title>The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice</title><title>British journal of general practice</title><addtitle>Br J Gen Pract</addtitle><description>Clinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse.
To ascertain whether a GP's global clinical judgement of future cognitive status has an added value for predicting a patient's likelihood of experiencing dementia.
Multicentre prospective cohort study among patients in German general practice that took place from January 2003 to October 2016.
Patients without baseline dementia were assessed with neuropsychological interviews over 12 years; 138 GPs rated the future cognitive decline of their participating patients. Associations of baseline predictors with follow-up incident dementia were analysed with mixed-effects logistic and Cox regression.
A total of 3201 patients were analysed over the study period (mean age = 79.6 years, 65.3% females, 6.7% incident dementia in 3 years, 22.1% incident dementia in 12 years). Descriptive analyses and comparison with other cohorts identified the participants as having frequent and long-lasting doctor-patient relationships and being well known to their GPs. The GP baseline rating of future cognitive decline had significant value for 3-year dementia prediction, independent of cognitive test scores and patient's memory complaints (GP ratings of very mild (odds ratio [OR] 1.97, 95% confidence intervals [95% CI] = 1.28 to 3.04); mild (OR 3.00, 95% CI = 1.90 to 4.76); and moderate/severe decline (OR 5.66, 95% CI = 3.29 to 9.73)). GPs' baseline judgements were significantly associated with patients' 12-year dementia-free survival rates (Mantel-Cox log rank test
<0.001).
In this sample of patients in familiar doctor-patient relationships, the GP's clinical judgement holds additional value for predicting dementia, complementing test performance and patients' self-reports. Existing and emerging primary care-based dementia risk models should consider the GP's judgement as one predictor. Results underline the importance of the GP-patient relationship.</description><subject>Aged</subject><subject>Clinical Decision-Making</subject><subject>Cohort analysis</subject><subject>Dementia</subject><subject>Dementia - diagnosis</subject><subject>Evidence-Based Practice</subject><subject>Family physicians</subject><subject>Female</subject><subject>General Practice</subject><subject>General Practitioners - standards</subject><subject>Germany - epidemiology</subject><subject>Humans</subject><subject>Judgment</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Physician-Patient Relations</subject><subject>Prospective Studies</subject><subject>Referral and Consultation - statistics & numerical data</subject><issn>0960-1643</issn><issn>1478-5242</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkUFr3DAQhUVpaLZpj70WQQ89OZEs25J6KITQJoVAckihNzGWx14ttuVK8kL-Qn91tUkampMYzTdvHvMI-cDZqRBan7W7YeH6l2QNE_IV2fBKqqIuq_I12TDdsII3lTgmb2PcMVaWDWdvyLHgta6kZBvy526LdA_jitT3NOXi8vZzpHZ0s7Mw0t3aDTjhnKib6RKwcza5eaDdw6eDLxTotI7J2VwGzIiPC2Zmj9T6rQ-JxrR29xQmn8cWSC6D8aA24Iwhr1gC2MP8O3LUwxjx_dN7Qn5-_3Z3cVVc31z-uDi_LmzF61SA6hvVS0QJtVAKOmZ7ELpjvOVMVWWrdF83GqVFwfuqtbwFJboGuFVay1KckK-PusvaTtg9GIfRLMFNEO6NB2dedma3NYPfm0YqwYXKAp-eBIL_vWJMZufXMGfPphT53LzOIWSqeKRsPkkM2D9v4MwcojMvosv8x_9tPdP_shJ_AT1jmRs</recordid><startdate>20191101</startdate><enddate>20191101</enddate><creator>Pentzek, Michael</creator><creator>Wagner, Michael</creator><creator>Abholz, Heinz-Harald</creator><creator>Bickel, Horst</creator><creator>Kaduszkiewicz, Hanna</creator><creator>Wiese, Birgitt</creator><creator>Weyerer, Siegfried</creator><creator>König, Hans-Helmut</creator><creator>Scherer, Martin</creator><creator>Riedel-Heller, Steffi G</creator><creator>Maier, Wolfgang</creator><creator>Koppara, Alexander</creator><general>Royal College of General Practitioners</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>5PM</scope></search><sort><creationdate>20191101</creationdate><title>The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice</title><author>Pentzek, Michael ; Wagner, Michael ; Abholz, Heinz-Harald ; Bickel, Horst ; Kaduszkiewicz, Hanna ; Wiese, Birgitt ; Weyerer, Siegfried ; König, Hans-Helmut ; Scherer, Martin ; Riedel-Heller, Steffi G ; Maier, Wolfgang ; Koppara, Alexander</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-a8f68f7ee7a5388ad0cfa39d01b10842b89f569e7ce31f4bc1ba83d6a1c899723</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Clinical Decision-Making</topic><topic>Cohort analysis</topic><topic>Dementia</topic><topic>Dementia - diagnosis</topic><topic>Evidence-Based Practice</topic><topic>Family physicians</topic><topic>Female</topic><topic>General Practice</topic><topic>General Practitioners - standards</topic><topic>Germany - epidemiology</topic><topic>Humans</topic><topic>Judgment</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Physician-Patient Relations</topic><topic>Prospective Studies</topic><topic>Referral and Consultation - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pentzek, Michael</creatorcontrib><creatorcontrib>Wagner, Michael</creatorcontrib><creatorcontrib>Abholz, Heinz-Harald</creatorcontrib><creatorcontrib>Bickel, Horst</creatorcontrib><creatorcontrib>Kaduszkiewicz, Hanna</creatorcontrib><creatorcontrib>Wiese, Birgitt</creatorcontrib><creatorcontrib>Weyerer, Siegfried</creatorcontrib><creatorcontrib>König, Hans-Helmut</creatorcontrib><creatorcontrib>Scherer, Martin</creatorcontrib><creatorcontrib>Riedel-Heller, Steffi G</creatorcontrib><creatorcontrib>Maier, Wolfgang</creatorcontrib><creatorcontrib>Koppara, Alexander</creatorcontrib><creatorcontrib>AgeCoDe Study Group</creatorcontrib><creatorcontrib>for the AgeCoDe Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of general practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pentzek, Michael</au><au>Wagner, Michael</au><au>Abholz, Heinz-Harald</au><au>Bickel, Horst</au><au>Kaduszkiewicz, Hanna</au><au>Wiese, Birgitt</au><au>Weyerer, Siegfried</au><au>König, Hans-Helmut</au><au>Scherer, Martin</au><au>Riedel-Heller, Steffi G</au><au>Maier, Wolfgang</au><au>Koppara, Alexander</au><aucorp>AgeCoDe Study Group</aucorp><aucorp>for the AgeCoDe Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice</atitle><jtitle>British journal of general practice</jtitle><addtitle>Br J Gen Pract</addtitle><date>2019-11-01</date><risdate>2019</risdate><volume>69</volume><issue>688</issue><spage>e786</spage><epage>e793</epage><pages>e786-e793</pages><issn>0960-1643</issn><eissn>1478-5242</eissn><abstract>Clinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse.
To ascertain whether a GP's global clinical judgement of future cognitive status has an added value for predicting a patient's likelihood of experiencing dementia.
Multicentre prospective cohort study among patients in German general practice that took place from January 2003 to October 2016.
Patients without baseline dementia were assessed with neuropsychological interviews over 12 years; 138 GPs rated the future cognitive decline of their participating patients. Associations of baseline predictors with follow-up incident dementia were analysed with mixed-effects logistic and Cox regression.
A total of 3201 patients were analysed over the study period (mean age = 79.6 years, 65.3% females, 6.7% incident dementia in 3 years, 22.1% incident dementia in 12 years). Descriptive analyses and comparison with other cohorts identified the participants as having frequent and long-lasting doctor-patient relationships and being well known to their GPs. The GP baseline rating of future cognitive decline had significant value for 3-year dementia prediction, independent of cognitive test scores and patient's memory complaints (GP ratings of very mild (odds ratio [OR] 1.97, 95% confidence intervals [95% CI] = 1.28 to 3.04); mild (OR 3.00, 95% CI = 1.90 to 4.76); and moderate/severe decline (OR 5.66, 95% CI = 3.29 to 9.73)). GPs' baseline judgements were significantly associated with patients' 12-year dementia-free survival rates (Mantel-Cox log rank test
<0.001).
In this sample of patients in familiar doctor-patient relationships, the GP's clinical judgement holds additional value for predicting dementia, complementing test performance and patients' self-reports. Existing and emerging primary care-based dementia risk models should consider the GP's judgement as one predictor. Results underline the importance of the GP-patient relationship.</abstract><cop>England</cop><pub>Royal College of General Practitioners</pub><pmid>31594770</pmid><doi>10.3399/bjgp19X706037</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0960-1643 |
| ispartof | British journal of general practice, 2019-11, Vol.69 (688), p.e786-e793 |
| issn | 0960-1643 1478-5242 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6783138 |
| source | MEDLINE; PubMed Central; Alma/SFX Local Collection |
| subjects | Aged Clinical Decision-Making Cohort analysis Dementia Dementia - diagnosis Evidence-Based Practice Family physicians Female General Practice General Practitioners - standards Germany - epidemiology Humans Judgment Male Medical diagnosis Physician-Patient Relations Prospective Studies Referral and Consultation - statistics & numerical data |
| title | The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-09T08%3A31%3A02IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20value%20of%20the%20GP's%20clinical%20judgement%20in%20predicting%20dementia:%20a%20multicentre%20prospective%20cohort%20study%20among%20patients%20in%20general%20practice&rft.jtitle=British%20journal%20of%20general%20practice&rft.au=Pentzek,%20Michael&rft.aucorp=AgeCoDe%20Study%20Group&rft.date=2019-11-01&rft.volume=69&rft.issue=688&rft.spage=e786&rft.epage=e793&rft.pages=e786-e793&rft.issn=0960-1643&rft.eissn=1478-5242&rft_id=info:doi/10.3399/bjgp19X706037&rft_dat=%3Cproquest_pubme%3E2316415147%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2316415147&rft_id=info:pmid/31594770&rfr_iscdi=true |