Annual wellness visits underutilized to detect cognitive impairment

Only about 12% of Medicare beneficiaries underwent an annual wellness visit in 2013, according to findings presented at the Alzheimer’s Association International Conference.

More than 16 million U.S. residents have cognitive impairment, according to the CDC.

“Detecting cognitive impairment earlier as part of the [annual wellness visit] may provide a meaningful opportunity to improve patient outcomes by facilitating appropriate diagnostic assessment for Alzheimer’s disease and related disorders, identifying possible causes, and initiating treatment,” J. Scott Andrews, PharmD, a research scientist at Eli Lilly and Company, told Healio Family Medicine in an interview. “However, we need to see wider recognition and utilization of this benefit.”

According to the Alzheimer’s Association, benefits of a timely diagnosis include the increased likelihood that patients will respond to treatment, and the opportunity to establish professional relationships with open communication between health care providers and patients.

Andrews and colleagues conducted a retrospective analysis of more than 2.3 million randomly chosen Medicare claims from 2011 to 2013. They divided them into two groups: those who had an annual wellness visit vs. those who did not. All patients were aged 65 years or older at index visit, were enrolled in Medicare parts A, B and D the year before and after the index visit, and had no sign of cognitive impairment in the previous year.

The final sample included 471,415 claims. Among these, only 11.8% of the patients in the study had undergone an annual wellness visit.

“Use of the [annual wellness visit] remains low,” researchers wrote. “However, the [annual wellness visit] is associated with differences in the proportions of patients receiving some lab tests, but differences in the rates of neuropsychological testing, diagnostic imaging and diagnoses of cognitive impairment were small. Standardizing how cognitive impairment is assessed in the [annual wellness visit] and how providers organize subsequent care are important areas for consideration to improve the detection of early [Alzheimer’s disease-related dementias].”

When asked how much standardization should occur, Andrews replied: “We think the recommendations published by the Alzheimer’s Association in 2013 serve as a great resource on how to operationalize detection of cognitive impairment in a primary care setting.”

This guidance includes the health care provider, patient and any other person familiar with the patient conduct a health risk assessment and discuss any concerns. Other tools such as the AD8, GPCOG, Mini-Cog, MIS or Short IQCODE can further evaluate the patient’s cognitive function, Andrews said.

“If this brief assessment triggers concerns, patients should then receive a full dementia evaluation,” he said. – by Janel Miller

Reference:

Alzheimer’s Association Webinar on Early Detection of Alzheimer’s Disease.

https://www.youtube.com/watch?v=3ENtatzyUic&feature=youtu.be. Accessed July 26, 2017.

CDC Cognitive Impairment: A Call to Action, Now!

https://www.cdc.gov/aging/pdf/cognitive_impairment/cogimp_poilicy_final.pdf. Accessed July 26, 2017.

Fowler NR, et al. Impact of the Medicare Annual Wellness Visit on the detection of cognitive impairment in primary care. Presented at: Alzheimer's Association International Conference; July 16-20, 2017; London.

Further reading:

Alzheimer’s Association 2013 Facts and Figures. https://www.alz.org/downloads/facts_figures_2013.pdf. Accessed July 26, 2017.

Alzheimer’s Association Cognitive Assessment Toolkit

https://www.alz.org/documents_custom/141209-CognitiveAssessmentToo-kit-final.pdf. Accessed July 26, 2017.

Disclosure: Healio Family Medicine was unable to confirm researchers’ relevant financial disclosures prior to publication.