Abstract
BACKGROUND: Cognitive impairment (CI) is projected to significantly increase as the population ages. While primary care clinicians are often the first point of contact for patients with cognitive decline, many clinicians report significant barriers to addressing CI in primary care, including lack of time, lack of established workflow, and low confidence in diagnosing and managing CI. METHODS: To address these barriers, a CI clinician decision support system (CI-CDSS) was developed and is being tested in a cluster randomized, controlled clinical trial in 38 primary care clinics. A secondary aim of the study was to assess whether the CI-CDSS increased clinician confidence in CI diagnosis and management, as measured by surveys administered before and 8-months after CI-CDSS implementation. Primary outcome results of CI diagnosis are awaiting the end of the follow-up period; however, clinician surveys are complete and reported here. The odds ratio (OR) for the interaction between survey time and study arm, estimated in a generalized linear mixed model, tested the significance of change in clinician confidence across study arms. The average marginal effect (AME), estimated in a generalized estimating equation, provided a treatment effect estimate. RESULTS: While self-reported use of the CI-CDSS was modest (32% remembered the tool and 65% of those used it), those who used it reported high satisfaction (97% said the tool helped provide better CI care). Clinicians in CI-CDSS clinics reported increased confidence in managing CI care relative to usual care (UC) clinicians (AME = 16.8, OR = 2.24 [1.05, 4.80]). Trending, but not significant, increases in clinician confidence in diagnosing CI were observed in CI-CDSS clinics when compared to usual care (e.g., distinguishing types of dementia AME = 9.8, OR = 2.08[0.84, 5.14]). CONCLUSIONS: The results of this study demonstrate the potential value of a CI-CDSS in promoting primary care clinician confidence in caring for and diagnosing patients with CI. TRIAL REGISTRATION: This trial is registered on clinicaltrials.gov, NCT05723523 on 02/02/2023.