Older adults with dementia: knowledge and attitudes of physicians in health units

Steiner, Ana Beatriz Quintes; Jacinto, Alessandro Ferrari; Citero, Vanessa de Albuquerque

doi:10.11606/s1518-8787.2020054002451

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Saúde Pública 54 • 2020 • https://doi.org/10.11606/s1518-8787.2020054002451 copy

Older adults with dementia: knowledge and attitudes of physicians in health units

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To describe the knowledge and attitudes of general practitioners of the basic health network of the city of São Paulo in relation to patients with dementia and identify patterns of attitudes.

METHODS:

A total of 10% of the basic health units in the city of São Paulo (n = 45) were randomly distributed into six regional health coordination centers. Up to two general practitioners were interviewed in each unit, with a total of 81 physicians interviewed. They answered the translated and cross-culturally adapted version for Brazil of two British questionnaires, the knowledge quiz (knowledge about dementias) and the attitude quiz (attitude towards the patient afflicted with dementia), as well as a sociodemographic and occupational questionnaire to understand the profile of general practitioners working in primary care. Descriptive data analysis, factor analysis of the main components of the attitude quiz and study of association between attitudes and knowledge were performed, in addition to the multiple linear regression test to determine the relationship between occupational profile and knowledge about attitude patterns in dementia.

RESULTS:

The physicians interviewed had a median of five-year graduation time; 35.8% worked exclusively with primary care, and less than 40% had completed, or were attending, medical residency or specialization. Physicians showed a lower knowledge about the diagnosis of dementia than about the epidemiology of the disease and its therapeutic management. Their attitudes towards patients afflicted with dementia resulted in four factors: proactive optimism, delegated optimism, implicit dismay, and explicit dismay. The regression study showed that the attitude of explicit dismay decreases the longer the weekly working hours of the physician in the units, and that the delegated optimistic attitude of the physician decreases in the same situation.

CONCLUSION:

Investment in training is essential to improve physicians' performance in the field of dementia in primary care.

DESCRIPTORS:
Physicians, Primary Care; Health Knowledge, Attitudes, Practice; Patients; Aged; Dementia

Items	Attitudes				Communalities ^* * Factor analysis allows the decomposition of the variance of each item into two parts: common part and specific part. The part of the common variance – due to common factors – is called communality. Values below 0.50 indicate that the corresponding items are underrepresented in factor analysis.
Items	FACTOR 1 Proactive Optimism	FACTOR 2 Delegating optimism	FACTOR 3 Implicit dismay	FACTOR 4 Explicit dismay
3. Much can be done to improve the quality of life of people with dementia	0.756	0.123	−0.100	−0.190	0.632
1. Much can be done to improve the quality of life of caregivers of people with dementia	0.718	−0.039	−0.375	0.154	0.682
4. Providing diagnosis is usually more useful than harmful	0.701	0.091	0.228	−0.004	0.552
5. Dementia is better diagnosed in specialized services	0.218	0.717	−0.285	−0.025	0.643
10. The primary care team plays a very limited role in the care of people with dementia	0.058	0.684	0.181	0.076	0.509
7. It is better to talk to the patient using euphemisms	−0.146	0.604	0.410	0.129	0.572
9. It is not worth referring families to specialized services when they do not want to use them	−0.164	0.207	0.732	0.100	0.616
2. Families prefer to be informed about their relatives' dementia as soon as possible	0.499	−0.147	0.647	−0.081	0.696
6. Patients with dementia may deplete resources with little positive results	0.144	−0.054	0.060	0.892	0.823
8. Treating dementia is often more frustrating than rewarding	−0.293	0.250	−0.001	0.671	0.599
Eigenvalues	2.03	1.50	1.44	1.35
Percentage (%) of the total variance explained	20.34	15.01	14.43	13.46
Cumulative percentage (%) of the total variance explained	20.34	35.35	49.78	63.24
Cronbach's Alpha	0.629	0.468	0.255	0.470

		Initial model		Final model
		Coefficient (95%CI)	p	Coefficient (95%CI)	p
Knowledge score
	Epidemiological	−0.04 (−0.19 – 0.12)	0.628	–	–
	Diagnosis	−0.24 (−0.50 – 0.02)	0.075	−0.25 (−0.49 – −0.02)	0.037
	Treatment	0.03 (−0.10 – 0.15)	0.665	–	–
Workload (hours/week)		−0.51 (−0.87 – −0.16)	0.005	−0.53 (−0.86 – −0.21)	0.002
Attended residency/specialization (ref. = no)
	Completed	−9.37 (−18.75 – 0.01)	0.050	−9.52 (−18.24 – −0.81)	0.033
	Studying	1.18 (−11.38 – 13.74)	0.852	–	–
Took, at some time in life, courses on cognitive alteration in older adults		−3.20 (−13.96 – 7.56)	0.555	–	–
Constant		76.34 (60.44 – 92.24)	< 0.001	76.69 (63.78 – 89.6)	< 0.001

		Initial model		Final model
		Coefficient (95%CI)	p	Coefficient (95%CI)	p
Knowledge score
	Epidemiological	−0.08 (−0.23 – 0.07)	0.315	–	–
	Diagnosis	0.25 (−0.01 – 0.50)	0.058	–	–
	Treatment	0.04 (−0.09 – 0.16)	0.571	–	–
Workload (hours/week)		−0.48 (−0.8 – −0.15)	0.005	−0.49 (−0.80 – −0.18)	0.003
Good basis on cognitive alterations in older adults during medical school (ref. = Did not have)
	Yes, I had	−6.64 (−15.2 – 1.92)	0.126	–	–
	I cannot remember	−13.88 (−29.6 – 1.84)	0.083	–	–
Took, at some time in life, courses on cognitive alteration in older adults		−7.31 (−18.12 – 3.49)	0.182	–	–
Constant		56.47 (42.31 – 70.63)	< 0.001	58.32 (47.68 – 68.97)	< 0.001

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Ana Beatriz Quintes Steiner, Centro de Atenção Integrada à Saúde Mental Vila Mariana Rua Major Maragliano, 241 04017-030 São Paulo, SP, Brasil E-mail: drabsteiner@yahoo.com.br