Dementia risk reduction in primary care: Barriers & enablers

Abstract

nBackground:nThe implementation of intervention strategies by primary care practitioners aimed at modifying risky lifestyle behaviors in patients has the potential to prevent or delay the onset of dementia. The main aim of this review was to identify and summarize the research evidence regarding barriers and enablers to dementia risk reduction in primary care. A secondary objective was to use this evidence to make recommendations to inform the Australian national dementia prevention strategy around the translation of evidence-based care into practice. This project was carried out as part of the work of the Dementia Collaborative Research Centres.nMethods:nA comprehensive search of the literature for English language publications up to October 2007 was undertaken using the electronic databases: MEDLINE, PubMed, PsycINFO, Health Source, CINAHL, Pre-CINAHL and the Cochrane library. Search terms included combinations of the keywords: dementia, chronic disease, mental disorders, neurology or geriatric, primary prevention, lifestyle modification/intervention, evidence based; one-to-one intervention, guideline and implementation strategies, prevention, preventive interventions, control of risk, guideline, practice, change in behaviour, behavioural change, dissemination and implementation strategies. Systematic reviews, meta-analyses and large scaled pooled analyses were retrieved in the first instance.nResults:nOf a total of 950 titles initially identified, 16 studies were included in this review, of which 12 were systematic reviews. Only one study examined the uptake of best practice in dementia care at the primary care level and only limited research has been undertaken to identify factors that impede the uptake of evidence based recommendations or guidelines by primary health care practitioners, generally. Identified barriers include factors that influence a physician's knowledge of, and attitudes towards guidelines as well as factors intrinsic to the guidelines themselves. Additional barriers also arise at the level of the patient or the health-care system or are specific to certain population groups and barriers to implementation vary across place and time. Case studies from Australia indicate the most problematic barriers for GPs include inadequate remuneration for complex clinical activities and time constraints.nConclusions:nConsiderable gaps in the knowledge base remain regarding factors that impede and facilitate the uptake of evidence based medicine. Of particular relevance for dementia are studies that examine the uptake of activities designed to prevent vascular disease in primary care. The limited evidence available indicates that, for a dementia risk reduction or screening activity to be effective, it should be quick and easy to administer, have a sound rationale and be readily incorporated into existing work processes.