Abstract
BackgroundMore than 90% of dementia patients are cared for by their general practitioners, who are decisively involved in the diagnosis, therapy and recommendation of support services. Objective: To test whether special training of general practitioners alters the care of dementia patients through their systematic recommendation of caregiver counseling and support groups.Method129 general practitioners enrolled 390 dementia patients and their informal caregivers in a prospective, three-arm cluster-randomized 2-year study. Arm A constituted usual care, in Arm B and C support groups and caregiver counseling (in Arm B one year after baseline, in Arm C at baseline) were recommended by the general practitioners. The general practitioners received arm-specific training. Diagnostic and therapeutic behavior of physicians was recorded at baseline. Informal caregivers were questioned in follow-up after 2 years about the utilization of support services.ResultsThe diagnostic behavior of the general practitioners conforms to relevant guidelines. The procedure in newly-diagnosed patients does not differ from previously diagnosed patients with the exception of the rate of referral to a specialist. About one-third of the newly-diagnosed dementia patients are given an anti-dementia drug. The utilization of support groups and counseling increased five- and fourfold, respectively. Utilization of other support services remained low (< 10%), with the exception of home nursing and institutional short-term nursing.ConclusionTrained general practitioners usually act in conformity with guidelines with respect to diagnosing dementia, and partly in conformity with the guidelines with respect to recommended drug therapy. Recommendations of support services for informal caregivers by the general practitioner are successful. They result in a marked increase in the utilization rate for the recommended services compared to offers which are not recommended by the general practitioner.Trial registrationISRCTN68329593
Highlights
More than 90% of dementia patients are cared for by their general practitioners, who are decisively involved in the diagnosis, therapy and recommendation of support services
The diagnostic behavior of the general practitioners conforms to relevant guidelines
The utilization of “caregiver support groups” and “informal caregiver counseling” recommended by the general practitioner at the start of the study was analyzed after 2 years
Summary
More than 90% of dementia patients are cared for by their general practitioners, who are decisively involved in the diagnosis, therapy and recommendation of support services. Medical care of elderly people in Germany is given by general practitioners in the majority of cases. This applies to dementia patients: more than 90% are diagnosed and cared for by the general practitioner [1] He is responsible for the initiation of the diagnostic process, the individual combination of pharmaceutical or non-pharmaceutical options and consultation with informal caregivers regarding support services available near the place of residence. There is frequent criticism that only a small number of dementia patients undergo appropriate diagnostics and receive appropriate therapy [7,8,14] This usually happens due to a lack of knowledge, but often because the diagnosis is taboo, the therapeutic options are apparently limited, or because it is feared that the doctor-patient relationship will suffer by bringing bad news
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