Conocimiento, actitudes y necesidades de calificación de profesionales de la atención básica en la atención a las demencias

Costa, Gislaine Desani da; Santos, Odineide Gomes dos; Oliveira, Maria Amélia de Campos

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Revista Brasileira de Enfermagem

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Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (suppl 3) • 2020 • https://doi.org/10.1590/0034-7167-2020-0330 copiar

Conocimiento, actitudes y necesidades de calificación de profesionales de la atención básica en la atención a las demencias

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Identificar el conocimiento y las actitudes de médicos y enfermeros en el rastreo, diagnóstico, tratamiento y acompañamiento de las demencias y sus necesidades educacionales.

Método:

Estudio transversal, realizado con 195 médicos y 274 enfermeros actuantes en la Estrategia Salud de la Familia, del municipio de São Paulo. Se utilizó el instrumento Atenção Sanitária às Demências: a visão da Atenção Básica. Los datos han sometidos a la estadística descriptiva.

Resultados:

Entre los médicos, 64,1% refirieron realizar el diagnóstico habitualmente, pero 23,1% en la fase leve; 89,2% mencionaran dificultades para identificar casos de la enfermedad; 94,9%, dificultades para tratamiento y acompañamiento de los pacientes (28,2%); 84,6% de los médicos y 79,2% de los enfermeros refirieron dificultades en el acompañamiento a la forma grave de la enfermedad.

Conclusión:

Identificaron lagunas en el conocimiento referentes al rastreo y diagnóstico de las demencias, acompañamiento de los pacientes, información diagnóstica y suporte al cuidador.

Descriptores:
Educación Profesional en Salud Pública; Atención Primaria a la Salud; Médicos; Enfermeras y Enfermeros; Demencia

Tracking and diagnosing dementia	Doctor		Nurse
Tracking and diagnosing dementia	n	%	n	%
Main signs and symptoms that lead to suspected dementia
Cognitive impairment with memory disorders	102	52.3	123	44.9
Psychological and behavioral symptoms of dementia (depression, delusions, agitation, personality changes)	67	34.4	137	50.0
Impaired ability to perform activities of daily living	41	21.0	85	31.0
Cognitive and functional assessment tests most used in clinical practice
Cognitive Capacity
Mini Mental State Examination	132	67.7	182	66.4
Global cognitive-functional assessment	13	6.7	16	5.8
Clock drawing test	13	6.7	14	5.1
Functional Capacity
Katz Index	43	22.1	124	45.3
Pfeffer's test	17	8.7	13	4.7
Main difficulties in identifying a case of dementia
Differentiating the signs and symptoms of dementia from geriatric depression	78	40.0	NA^* * Not Applicable.	NA^* * Not Applicable.
Differentiating the signs and symptoms of dementia from normal aging	68	34.9	NA^* * Not Applicable.	NA^* * Not Applicable.
Main aspects that make it difficult to identify a case of dementia
Lack of time to carry out the diagnostic process (apply tests, analyzes)	110	56.4	NA^* * Not Applicable.	NA^* * Not Applicable.
Little confidence in the diagnosis (doubts around the patient having true dementia)	37	19.0	NA^* * Not Applicable.	NA^* * Not Applicable.
Most requested complementary tests for the diagnosis of the dementia subtype
Complete blood count	113	57.9	NA^* * Not Applicable.	NA^* * Not Applicable.
Thyroid-stimulating hormone	112	57.4	NA^* * Not Applicable.	NA^* * Not Applicable.
Vitamin B12	109	55.9	NA^* * Not Applicable.	NA^* * Not Applicable.
Biochemical examination with glycemia	108	55.4	NA^* * Not Applicable.	NA^* * Not Applicable.
Serology for syphilis	107	54.9	NA^* * Not Applicable.	NA^* * Not Applicable.
Renal function	95	48.7	NA^* * Not Applicable.	NA^* * Not Applicable.
Liver enzymes	94	48.2	NA^* * Not Applicable.	NA^* * Not Applicable.
Serology for human immunodeficiency virus	89	45.6	NA^* * Not Applicable.	NA^* * Not Applicable.
Folic acid	68	34.7	NA^* * Not Applicable.	NA^* * Not Applicable.
Calcium	61	31.3	NA^* * Not Applicable.	NA^* * Not Applicable.
Magnetic resonance imaging of the skull	32	16.4	NA^* * Not Applicable.	NA^* * Not Applicable.

Diagnostic information of the dementia	Doctor
Diagnostic information of the dementia	n	%
Diagnostic information of the dementia
To the patient
Never	40	20.5
Rarely	63	32.4
Sometimes	58	29.7
Frequently	34	17.4
To Family members
Never	13	6.7
Rarely	47	24.2
Sometimes	48	24.7
Frequently	86	44.3
Main causes that influence not informing the patient of the diagnosis of dementia
Not having enough capacity to comprehend the information about the diagnosis	67	34.4
Being in an advanced stage of the disease	42	21.5
The family does not want the patient to know the diagnosis	15	7.7
Possibility of the diagnosis causing negative effects on the patient's daily life	12	6.2

Monitoring of dementia	Doctor		Nurse
Monitoring of dementia	n	%	n	%
Medical services available in the coverage area for referral of dementia cases for diagnosis and/or control
Reference neurologist	126	64.6	NA^* * Not Applicable.	NA^* * Not Applicable.
Elderly Reference Center	124	63.6	NA^* * Not Applicable.	NA^* * Not Applicable.
Ambulatory of Medical Specialties	81	41.5	NA^* * Not Applicable.	NA^* * Not Applicable.
Hospital neurology service	18	9.3	NA^* * Not Applicable.	NA^* * Not Applicable.
Ambulatory of Dementia Specialties	14	7.2	NA^* * Not Applicable.	NA^* * Not Applicable.
Main roles of the nursing team in monitoring patients with dementia in Primary Care
Periodic assessment of cognitive impairment	NA^* * Not Applicable.	NA^* * Not Applicable.	116	42.3
Home risk assessment	NA^* * Not Applicable.	NA^* * Not Applicable.	85	31.0
Supporting caregiver and/or family needs	NA^* * Not Applicable.	NA^* * Not Applicable.	73	26.6
Control of patient's comorbidities	NA^* * Not Applicable.	NA^* * Not Applicable.	61	22.3
Periodic assessment of functional impairment	NA^* * Not Applicable.	NA^* * Not Applicable.	59	21.5
Pharmacological prescription and therapeutic follow-up control	NA^* * Not Applicable.	NA^* * Not Applicable.	46	16.8
Cognitive stimulation activities	NA^* * Not Applicable.	NA^* * Not Applicable.	38	13.9
Main difficulties for the treatment and monitoring of patients with dementia in Primary Care
Treatment with specific drugs (anticholinesterase and/or memantine)	63	32.3	NA^* * Not Applicable.	NA^* * Not Applicable.
Monitoring and treating a patient with dementia requires a large amount of time, not available in Primary Care	61	31.3	NA^* * Not Applicable.	NA^* * Not Applicable.
The support needs of the caregiver and/or the family	55	28.2	NA^* * Not Applicable.	NA^* * Not Applicable.
Difficulties in monitoring patients with severe dementia
Yes	165	84.6	217	79.2
No	30	15.4	57	20.8
Main reasons
Pharmacological treatment is complex	89	45.6	NA^* * Not Applicable.	NA^* * Not Applicable.
No specialized service support	77	39.5	121	44.3
Patients are difficult	NA^* * Not Applicable.	NA^* * Not Applicable.	81	29.7
Their demands are not solvable in Primary Care	70	35.9	101	37.0
Require many home visits	48	24.6	43	15.8

Monitoring of dementia	Would not Recommend						Would Recommend
	Never		Almost Never		Few times		Sometimes		Almost Always		Always
	n	%	n	%	n	%	n	%	n	%	n	%
Medical recommendation
Vitamins	18	9.2	23	11.8	25	12.8	38	19.5	45	23.1	23	11.8
Natural/herbal treatments	60	30.8	51	26.2	25	12.8	18	9.2	8	4.1	4	2.1
Anticholinesterase drugs	24	12.3	24	12.3	34	17.4	31	15.9	32	16.4	20	10.3
Memantine	22	11.3	21	10.8	28	14.4	43	22.1	30	15.4	26	13.3
Tricyclic antidepressants	28	14.4	34	17.4	27	13.8	45	23.1	25	12.8	5	2.6
Selective serotonin reuptake inhibitor antidepressants	21	10.8	24	12.3	30	15.4	54	27.7	29	14.9	5	2.6
Typical antipsychotics	32	16.4	43	22.1	33	16.9	37	19.0	19	9.7	2	1.0
Atypical antipsychotics	34	17.4	45	23.1	33	16.9	41	21.0	9	4.6	2	1.0
Memory exercises (in general)	5	2.6	5	2.6	8	4.1	6	3.1	43	22.1	120	61.5
Cognitive stimulation (specific)	6	3.1	2	1.0	11	5.6	12	6.2	40	20.5	109	55.9
Music therapy, aromatherapy	31	15.9	22	11.3	21	10.8	26	13.3	27	13.8	45	23.1
Assistance in a daycare center for the elderly	10	5.1	14	7.2	19	9.7	40	20.5	36	18.5	64	32.8
Admission to a long-term care facility for the elderly	75	38.5	58	29.7	22	11.3	5	2.6	1	0.5	5	2.6
Referral to a specialist	2	1.0	3	1.5	5	2.6	26	13.3	46	23.6	101	51.8
Visit from a social worker	11	5.6	23	11.8	31	15.9	40	20.5	32	16.4	40	20.5
Association of family members of Alzheimer's patients	31	15.9	23	11.8	17	8.7	28	14.4	23	11.8	50	25.6

Monitoring of the caregiver	Doctor		Nurse
Monitoring of the caregiver	n	%	n	%
Planning frequency for monitoring the caregiver of patients with dementia
Never	27	13.8	15	5.5
Rarely	55	28.4	69	25.2
Sometimes	69	35.6	100	36.5
Frequently	43	22.2	90	32.8

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[1] Corresponding author: Gislaine Desani da Costa. E-mail: gislaine_desani@hotmail.com