Alzheimer's Disease:
Cognitive Memory Screening and Referral Program
Alzheimer's disease (AD) is a serious, progressive and fatal type of dementia that destroys brain cells and causes problems with memory, thinking, and behavior. AD is the most common type of dementia and is the sixth-leading cause of death in the United States. There is no cure for patients diagnosed with AD, and its prevalence increases dramatically with age. An estimated 36 million people currently have dementia worldwide, including over 5 million Americans with AD. Over 115 million people across the globe will have dementia by 2050, and in America, the number of people aged 65 years or older with AD could increase by 50 percent by 2050.
View below to learn how the project addressed the issue and view the full manuscript here.
The Background
Pharmacists have a unique opportunity to identify and manage individuals with AD and other cognitive memory disorders. The Cognitive Memory Screening and Referral Program (CMSRP) is the first project to measure the impact of a pharmacist-based cognitive memory screening service delivered in community pharmacy practice in the United States. While the involvement of community pharmacists in the screening of AD is novel in the US and across the globe, there are several studies supporting community pharmacists having a significant role in screening of diseases.
Key Objectives
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Evaluate the impact of pharmacy-based cognitive memory screening on outcomes of referral of at-risk patients to their primary care physician.
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Measure patient satisfaction with advanced clinical services and the willingness of patients to pay for cognitive memory screening services.
The Participants
Patients
The participating pharmacies identified and screened 161 patients with more than one warning sign for AD. The participants were members of the local communities surrounding the two pharmacy locations.
Pharmacies
Ten Fred Meyer Pharmacies located in the Portland, Oregon area and two Kerr Drug
Pharmacies located in North Carolina served as the study sites for this project. Each had one or more pharmacists on site during screening events. Participating study pharmacists were trained via a live Webinar training program that provided:
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An overview of the APhA Foundation CMSRP Program;
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A clinical update on AD;
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A review of the patient care process;
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A detailed overview of study forms and paperwork;
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Strategies for patient identification;
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Training on the use of memory screening instruments; and
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A protocol review for patient follow-up, data collecting and reporting.
The Methods
Enrollment
Services were offered to patients identified within the pharmacy practice and through awareness activities such as posters and informational brochures. Pharmacists delivered screening services to patients by appointment, through stand-alone screening days and through outreach to local assisted living facilities and senior centers.
Patients were offered screening services by the pharmacist if they self-identified as having at least one warning sign for AD as outlined by the Alzheimer’s Association or if the pharmacist assessed that the patient could benefit from the service based on factors such as age, co-morbid health conditions and/or observation of behaviors.
The memory screening tools were selected based on the ability to provide meaningful results to patients and physicians, the ease of implementation in a community pharmacy setting, and the small time commitment for both the pharmacist and the patient.
Following the administration of cognitive memory screening assessments, pharmacists provided counseling and disease education to patients and caregivers as required. Counseling was customized based on patient characteristics, medical history, medication therapy and responses to the HRA questions.
Assessment scoring guidelines were used by pharmacists to refer patients for physician follow-up. The scores for each patient assessment and the resulting action taken by the pharmacist were documented. If assessment scores demonstrated a cognitive deficiency in any of the three tests, patients could be referred to the physician.
The Results
Screening Outcomes
Evaluation
Screenings were evaluated by:
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Identifying how many patients pharmacists appropriately referred and did not refer to their physicians for further evaluation
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How many patients referred planned to go to their physicians for follow-up
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How many of those referred patients actually followed up with their physicians.
Patient satisfaction with services was evaluated through two mechanisms:
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The completion of a voluntary participant satisfaction survey provided to patients at the time they received their screening assessment.
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Follow-up phone calls from the pharmacist to participating patients 45 to 90 days after the initial pharmacy-based screening.
Results were published in December 2013 in the International Journal of Clinical Pharmacy. Read them here.