Effect of a dementia care management intervention on primary care provider knowledge, attitudes, and perceptions of quality of care

OBJECTIVES: To evaluate the effect of a multicomponent dementia care management program on primary care provider knowledge, attitudes, and perceptions of quality of dementia care. DESIGN: A clinic-level randomized, controlled trial of a comprehensive care management program for patients with dementia and their nonprofessional caregivers. The program included provider education and protocols for care managers to communicate with patients' medical providers. SETTING: Sixteen clinics (eight intervention, eight usual care) in three healthcare systems in San Diego, California. PARTICIPANTS: Two hundred thirty-two medical providers; 129 from eight intervention clinics; 103 from eight usual-care clinics. MEASUREMENTS: Providers were surveyed 9 months after intervention onset on knowledge (five items on four topics), attitudes about dementia (three items), and perception of quality of dementia care in their practice setting (three items). Multivariable linear and logistic regression models were used to evaluate the differences between intervention and usual-care providers, adjusting for covariate effects across groups and clustering by clinic. RESULTS: One hundred sixty-six of 232 (72%) providers responded. Intervention providers had better knowledge about assessing decision-making capacity than usual-care providers (adjusted difference in percentage correct=12%; adjusted odds ratio=2.4, 95% confidence interval=1.2-4.8). Intervention providers viewed dementia patients as more difficult to manage in primary care than usual-care providers (P=.03). There were no other differences in knowledge, attitudes, or care quality perceptions across intervention and usual-care providers. CONCLUSION: A comprehensive dementia care management model resulted in few differences in provider knowledge or attitudes favorable to dementia care, suggesting that this care model's effects on quality were primarily mediated through other components of the care management program.