Ambulatory Care for Dementia in Switzerland: Results of a Nationwide Survey

Background The early and correct identification and treatment of memory disorders is crucial for the well-being and prognosis of persons with dementia and their families. Family physicians are in the key position, but previous surveys showed, that their competency regarding this task is too low, although they regard dementia diagnosis as part of their job. Method After a pilot study with personal interviews we designed a web-based survey. It presented case vignettes, case 1 with mild cognitive impairment in a male or female version, case 2 describing a moderate dementia syndrome in a female multimorbid person. Three alternatives described a typical course of vascular dementia, Alzheimer dementia and Lewy Body dementia. One version of case 1 and case 2 each were randomized to the participants. The questionnaire consisted of open questions and those with given answer categories. Results From 7‘603 invitations and additional reminders, we received 709 full answers (9.3%). The physicians were family physicians (50.7%), specialists for internal medicine (23.2%), psychiatrists (21.9%) and neurologists (3.5%). The respondents were representative regarding age and sex distribution for swiss physicians. Regarding diagnosis, a vascular concept of memory disorders is still strong. Alzheimer dementia is still considered by a low number of physicians. For the investigations neuropsychological screening tests were cited frequently, neuroimaging less often. Antidementia drugs were considered in about 60% of case 1 and less frequently in case 2. Non-drug approaches covered a wide range of activities and were mentioned by two thirds of the physicians. Conclusion Compared to previous surveys using other methods we detect some improvement in guideline adherence. However there still remains much to do to improve medical outpatient care. We thank the Swiss Alzheimer Associaton for funding this study.