National Patterns of Dementia Treatment: RESULTS

A total of 25,561 patient visit records of individu als over the age of 60 were included in the study population from NAMCS 2000-2002, which based on patient visit weights represented a national sample of 768 million office visits made to stand-alone, private physicians’ clinics by the elderly. The mean age associated with this population was 73.4 ±8.0 years. As shown from the study demographics in Table 1, the majority of the patient visit records were from white (89.2%) and female patients (59.1%). Public insurance, i.e., Medicare or Medicaid (67.3%), was the predominant form of insurance among the study population. Additionally, about one-third of the patient visit records were from physician practices located in the south (31.7%) and most of them were in a metropolitan statistical area (MSA) (81.5%).

Table 1. Demographic characteristics of the study population

Patient Visit Characteristic Total Population (%) N=768#
AgeMean age 73.4(SD* 8.0) years
Race White Nonwhite 89.2 10.8
Gender Female Male 59.1 40.9
Insurance Other Private Public 7.1 25.6 67.3
RegionNortheast

Midwest

South

West

24.0 22.3 31.7 22.0
Metropolitan Statistical Area (MSA) MSANon-MSA 81.5 18.5
# number in millions; * SD: standard deviation

Based upon unweighted frequencies, 0.60% (155 out of 25,561) of the total patient visit records had a dementia diagnosis. Dementia of the Alzheimer’s type and senile dementia constituted 75.4% (117/155) and 18.1% (28/155) of the dementia-related visits, respectively. The majority of the dementia/AD visit records were from white patients (145/155=93.5%) and women (93/155=60.6%, Table 2). Additionally, persons over the age of 75 (105/155=67.7%)) and individuals with public insur­ance (116/155=74.8%) comprised most of the dementia-/AD-related visits (Table 2). With regard to physician specialty, the highest proportion of the dementia/AD visits were to neurologists and psychiatrists combined (73% or 113/155, Table 2). Similar to the overall study population, the dementia/AD visit records were mostly from clinics in the south and designated MSAs.
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Table 2. Patient visit characteristics of populations with dementia or Alzheimer’s disease status in NAMCS, 2000-2002

Patient Visit Characteristic Unweighted Frequency (%)* N=155

Age

61-74

50

>75

105

Race

White

145

Nonwhite

10

Gender

Female

93

Male

62

Region

Northeast

24

Midwest

30

South

63

West

38

Metropolitan Statistical Area (MSA)

MSA

128

Non-MSA

27

Physician’s Specialty

Other

42

Psychiatry

20

Neurology

93

Insurance

Private

30

Public

116

Other

9

* Percentage indicates level-specific prevalence

The prevalence of dementia between males and females was found to be similar (0.7% vs. 0.5%) and no association was found between gender and dementia/AD status (OR=1.28; 95% CI: 0.91, 1.78). From the race-specific findings of the study, 6.5% of the dementia- associated visit records (10/155) were associated with nonwhite persons, and AD was the common form of dementia, comprising 80% of the diagnoses in this subpopulation. Further, evaluation of dementia/AD status by race suggested that nonwhite patients were less likely to be diagnosed with dementia/AD, but this association was not statistically significant (OR=0.64; 95% confidence interval of 0.32,1.24). revatio 20 mg

Table 3. Visit characteristics by prescriptions

Patient Visit Characteristic Unweighted Frequency (%)* N=72

Age

61-74

27

>75

45

Race

White

66

Nonwhite

6
Gender

Female

49

Male

23
Region

Northeast

9

Midwest

8

South

37

West

18
Metropolitan Statistical Area (MSA)

MSA

64

Non-MSA

00
Physician’s Specialty

Other

10

Psychiatry

13

Neurology

49
Insurance

Private

12

Public

58

Other

2
* Percentage indicates level-specific prevalence

Of the dementia-/AD-related patient visits, 46.5% (72/155) resulted in a cholinesterase inhibitor drug mention. Of the dementia/AD visits with cholinesterase inhibitor, the most prevalent cholinesterase inhibitor was donepezil medication (68.0%; 49/72), followed by (26.0%; 19/72) and galantamine (6.0%; 4/72). No tacrine was prescribed. Of the demen­tia-/AD-related visits with cholinesterase inhibitor, 83.3% (60/72), 13.8% (10/72), 2.8% (2/72) and 0% (0/72) had AD, senile dementia, vascular dementia and senility diagnoses, respectively. Further subgroup analyses indicated that there was a statistically significant association between AD diagnosis and cholinesterase inhibitor prescription (OR=2.28; 95% CI: 1.05,4.95); no such association was found with the other types of dementia diagnoses.

Table 4. Predictors of cholinesterase inhibitor prescription among dementia or Alzheimer’s disease visits

Patient Visit Characteristics

Unadjusted Odds Ratio

Adjusted Odds Ratio

P Value

Age

61-74

>75

Reference (1.00) 0.64 (0.31-1.33) Reference (1.00) 0.75 (0.35-1.6)

0.45

Race White Nonwhite Reference (1.00) 1.80 (0.42-7.97) Reference (1.00) 1.81 (0.39-8.50)

0.45

Gender Female Male Reference (1.00) 0.53 (0.26-1.07) Reference (1.00) 0.53 (0.26-1.07)

0.06

Insurance Private Public Other Reference (1.00) 1.50 (0.62-3.67) 0.43 (0.05-2.94) Reference (1.00) 1.63 (0.60-4.47) 0.40 (0.06-2.78) 0.34 0.36
Metropolitan Statistical Area (MSA)MSA                                        Reference (1.00)

Non-MSA                                     0.42 (0.16-1.11)

Reference (1.00) 0.44 (0.16-1.23)

0.11

Physician’s SpecialtyOther

Psychiatry

Neurology

Reference (1.00) 5.94 (1.62-27.71)* 3.56 (1.47-8.80)* Reference (1.00) 5.45 (1.49-19.94)* 2.60 (1.05-6.45)* 0.01* 0.03*
RegionNortheast

Midwest

South

West

Reference (1.00) 0.61 (0.16-2.23) 2.37 (0.82-6.99) 1.50 (0.47-4.86) Reference (1.00) 0.66 (0.18-2.36) 1.83 (0.64^5.23) 1.61 (0.51-5.15) 0.52 0.25 0.41
* p<0.05

As shown in Table 3, cholinesterase inhibitor prescription varied widely by visit characteristics. Of the dementia/AD visits, visits made by individuals who were 75 years and older were the majority of the cholinesterase inhibitor recipients (45/72 or 62.5%). About half (52.7%) of female patients received a cholinesterase inhibitor prescription, but only one in three male patients (37.1%) received a cholinesterase inhibitor prescription (data not shown). About two-thirds of the visits with cholinesterase inhibitor prescriptions (49/72=68.2) were female patients (Table 3). Visit records from the south and those in a metropolitan area had the highest prevalence of cholinesterase inhibitor prescription compared to all the other regions and those not in a metropolitan area, respectively (Table 3). In comparing all physician specialties, the majority of the dementia/AD patients with a cholinesterase inhibitor were seen by neurologists (49/72 or 68.1%, Table 3).

Evaluation of the predictive factors of cholinesterase inhibitor prescription is summarized in Table 4. Psychiatrists (OR=5.5; 95% CI: 1.5, 19.9) and neurologists (OR=2.6; 95% confidence interval of 1.1, 6.5) were more likely to prescribe cholinesterase inhibitor as compared to other physicians. On the contrary, the type of patient insurance, gender and race of the patient did not show statistical significance in the model.

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