Primary care doctors and nurse practitioners, rather than specialists, are more likely to provide care for early-onset dementia in rural areas, putting these patients and clinicians at a disadvantage, say the authors of a new study. The researchers recommend innovative approaches to ensuring specialty care for patients, and training or guidance for clinicians.
Investigators analyzed the health records of 71,000 adults with early-onset Alzheimer’s disease and related dementias (ADRDs). Among patients with new early-onset ADRDs, those in rural areas had fewer neuropsychological tests, fewer visits to clinical psychologists, and greater odds of a diagnosis and subsequent care by primary care physicians and nurse practitioners than patients living in urban areas, investigators found.
The dearth of dementia care is not ideal, the researchers wrote. Rural primary care doctors may be overburdened and are not necessarily trained in dementia diagnosis and care. Patients, meanwhile, may fare better with specialized care and infrastructure, they explained.
“Specialty care, including neuropsychological assessments, are pretty critical for people with dementia to get an accurate diagnosis and set a symptom management plan,” said Wendy Yi Xu of Ohio State’s College of Public Health, in a statement accompanying the study’s publication in JAMA Network Open. “These are advanced, complex tests that most primary care physicians are not trained to perform.”
Telehealth, specialty consults
Given the increasing rate of early-onset ADRDs, community healthcare leaders and policymakers must look for ways to deliver necessary care to these patients, Xu and colleagues wrote. The researchers recommended an increase in specialist telehealth visits, added dementia training for primary care providers, and boosted availability of specialist consultations for these physicians.
“Clinician training or consultative guidance to PCPs may be viable options to help overcome neuroscience workforce deficiencies in rural areas,” they concluded.
Nearly 1 in 5 Americans live in a rural area, according to the Department of Health and Human Services. On Monday, HHS announced federal investments of nearly $60 million to increase the healthcare workforce in an effort to improve access to quality health care in rural communities.
Nearly $10 million will go toward establishing new medical residency programs in rural communities to boost the number of physicians trained in these settings, HHS reported.
The study was published in JAMA Network Open.