Consultation analysis of dementia triads in Portuguese general prac-tice: exploratory study

Abstract

Introduction: Despite policy recommendations worldwide, too often dementia remains outside the scope of primary health care. In the context of Portuguese primary health care services, our group previously explored the experiences of people with dementia, carers, general practitioners (GPs), and other professionals, together with their perspectives on barriers to dementia care. However, we know little about triadic consultations that involve a patient, their carer, and their GP. Objective: To explore dementia care in triadic consultations in general practice. Methods: Analysis of ten consultations with dementia triads across six Portuguese practices from different social contexts. Purposive sampling was used to recruit nine GPs, ten patients, and ten carers. Triadic consultations were digitally recorded, transcribed, and analysed. The analytical framework combined codes derived from the transcripts with codes from the available literature. Themes focused on the corollaries of dementia (e.g. need for information), and coordination of services. Results: Dementia-related content took up only 30% of consultations, despite their length (median 27 min). The GPs did not seem engaged in dementia management, their assessments lacked breadth and person-centredness, and interventions were limited. Carers facilitated GPs’ assessment of dementia consequences, but their needs were poorly assessed. Patients’ self-expression was limited by communication patterns within the triad. Conclusion: It is challenging for GPs to assess dementia among other conditions in a context of fragmented care. Strategies for improving family carers’ assessments are needed. The analysis of triadic consultations may provide potential process measures for assessing the quality of clinical practice and consultation training in general practice, but this requires further study.