Abstract
BackgroundGPs play an important role in recognising the symptoms of dementia; however, little is known about how they perceive their actual and future role in diagnosing dementia.AimTo explore Dutch GPs’ perceptions of their current position in diagnosing dementia, their reasons for referral to secondary care, and views on the future diagnostic role of GPs.Design and settingA qualitative study among Dutch GPs.MethodEighteen GPs participated in a semi-structured interview that ranged from 20 to 60 minutes. Interviews were transcribed verbatim and thematic analysis was performed.ResultsGPs reported that their role in the diagnostic phase of identifying people with suspected dementia is limited to recognising cognitive problems and deciding whether a patient needs to be referred for further investigation, or whether care could be organised without specialist diagnosis. GPs indicated that they were likely to refer patients if patients/caregivers or dementia case managers requested it, or if they thought it could have consequences for treatment. Typically, GPs do not see the need for referral when their patients are very old and declining slowly. GPs would welcome a more prominent role in diagnosing dementia in their own practice.ConclusionDiagnosing dementia involves a complex balance between patient and carer preferences, the consequences for treatment and care, and the burden of referral. Dutch GPs favour a stronger involvement in diagnosing dementia provided that both resources and diagnostic algorithms are improved.
Highlights
Dementia is one of the major causes of disability and dependency among older people
Diagnosing dementia involves a complex balance between patient and carer preferences, the consequences for treatment and care, and the burden of referral
Dutch GPs favour a stronger involvement in diagnosing dementia provided that both resources and diagnostic algorithms are improved
Summary
47.5 million people experience dementia and there are 7.7 million new cases every year.[1] Alzheimer’s disease is the most common form of dementia in older patients and may contribute to 60–70% of cases.[1] In the Netherlands, dementia is a clinical diagnosis that can be made by GPs or through referral to a specialist.[2] Previous studies revealed several challenges GPs experience in diagnosing dementia, such as lack of time,[3,4,5,6] diagnostic uncertainty,[5,6,7] inadequate payment models,[8] therapeutic nihilism (‘nothing can be done’),[8] and the fear of stigmatising patients by association with the diagnosis.[3,5,9] As a result, GPs appear to carry out a ‘watchful waiting process’ on people presenting with symptoms suggestive of dementia,[10] and dementia appears to be underdiagnosed with an estimated 50% of primary care patients >65 years not being diagnosed by their GPs.[11] therapeutic interventions to stop or slow the course of dementia have proven disappointing, a timely diagnosis of dementia is advocated by some, because it can empower individuals and their caregivers to comprehend the diagnosis and participate in the planning of care.[12,13]. GPs play an important role in recognising the symptoms of dementia; little is known about how they perceive their actual and future role in diagnosing dementia
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