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Rural Oregonians To Benefit From New Dementia Study By OHSU Oregon Rural Practice-Based Network

A new program is coming to rural Oregonians to help their physicians identify dementia at an earlier stage through the Oregon Health & Science University Oregon Rural Practice-based Network (ORPRN).

A new program is coming to rural Oregonians to help their physicians identify dementia at an earlier stage through the Oregon Health & Science University Oregon Rural Practice-based Network (ORPRN).

"We have found that it is often difficult for physicians to know when to screen for dementia. Many patients who are cognitively impaired have not been diagnosed by their doctors. The challenges of effectively diagnosing and caring for Alzheimer's patients and other people with dementia are even greater in rural practices. Additionally, the proportion of elderly in rural communities is often higher than in urban and suburban communities," said Linda Boise, M.P.H., Ph.D., associate professor of neurology, OHSU School of Medicine, information/education core director, OHSU Layton Center for Healthy Aging. Boise is the principal investigator of the study aimed at seeing what works in helping rural physicians identify patients with dementia.

The Rural Older Adult Memory Study (ROAM), coming to seven rural health centers in January 2007, will include a specially designed screening process for physicians to use with elderly patients to detect dementia. The physicians, as well as other health care providers, will also ask family members if they have noticed any cognitive changes in the patient.

"We are excited that the ROAM study will be helpful to us by showing if a screening tool can quickly and accurately find dementia at an early stage," said Robbie Law, M.D., Dunes Family Health Clinic, Reedsport.

"Identifying dementia early will be valuable to prevent basic risks for patients' safety, for instance,  medication errors, or problems in remembering to make and keep follow-up appointments. This will also encourage planning to avoid a crisis if a patient eventually cannot live independently, and to find resources to help patients cope with changes in their functioning.

"ORPRN is a terrific way to investigate this question by having rural clinicians doing the research in their own practices, where the results of the study will have direct impact, which is somewhat different from traditional academic research methods," Law said.

In a decade of studying dementia, Boise has found that as many as 50 percent of cognitively impaired patients are not evaluated or diagnosed. There are a number of reasons for this:  physicians' non-recognition of symptoms, the restricted length of patients' visits in primary care combined with the subtlety of symptoms of dementia especially in early dementia; a lack of follow-through on behavioral signs, even when noted in the medical chart. Sometimes physicians don't follow through because there is a perception that there is little they can do to help.

"This attitude, however, flies in the face of reports by families who wish they had known sooner that their relative had dementia. Although receiving a diagnosis of dementia can be emotionally devastating, it can also be a relief to family members when they know that something is wrong," Boise said.

Even though medical treatment is limited, families welcome help in better understanding the nature of the cognitive impairment and the resources to help them cope.

Several studies have found that primary care physicians would welcome education in dementia care. In an unpublished survey of 137 Oregon physicians conducted in 2004 by Boise, 82 percent reported that clinician training on Alzheimer's disease was needed.  Fifty-five percent checked dementia screening tools as one of the top three needs to help them provide better care and 77 percent indicated that diagnostic screening tools would be very useful in their practice.

The ROAM study is funded for one year through a $100,000 grant from the federal Agency for Healthcare and Research Quality.

The mission of the Oregon Rural Practice-based Research Network is to improve the health of rural populations in Oregon through conducting and promoting health research in partnerships with the communities and their practitioners.

The network includes 36 physicians' offices located in rural communities throughout the state.  These practices include 120 primary care clinicians who provide care for more than 150,000 patients.  Current network research projects include studies on child and maternal health, obstetrics, immunizations, medication safety, and osteoporosis.

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ROAM Study Sites

Dunes Family Health Clinic
620 Ranch Road
Reedsport, OR 97467
541 271-2163
Robbie Law, MD. Janet Patin, M.D.
Ron Vail, MD, Katy Gustafson, M.A.

Health Associates of Peace Harbor
380 Ninth St.
Florence, OR 97439
541 997-7134
Ronald Shearer, M.D., Michael Hodulik, M.D.,
Jenny Lockler, M.A., Susan Carnahan, M.A.

David M. Bice, M.D.
1010 SW Bay St.
Newport, OR 97365
541 265-6681
David M. Bice, M.D., Cathy Webb, L.P.N/

Bayshore Family Medicine
P.O. Box 655
Pacific City, OR 97498
503 965-6555
Craig Brown, M.D., Albert Thompson, M.D.,
Jenny Crippen, M.A., Katy Jensen, L.P.N.,
Sydney Thompson, practice manager

Rinehart Clinic
P.O. Box 176
Wheeler, OR 97147
503 368-5182
Harry A. Rinehart, M.D.,
Theresa Shipman, M.A.

Pacific Family Medicine
2055 Exchange St. Ste. 190
Astoria, OR 97103
503 325-5300
Katherine Merrill, M.D., Angela Nairn, M.D.,
Ebby Titmus, L.P.N., Paula Crawford, M.A.

OHSU Family Health Center
51377 Old Portland Road Ste. C
Scappoose, OR 97056
503 543-3181
Brian Rugge, M.D.,
Diane Hutson, practice manager

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