Facilitators and barriers for implementation of an easy, care-based Dementia Training Programme for general practitioners and primary care nurses: A qualitative study

Abstract

Dementia is under-diagnosed in primary care. To overcome this problem, we designed a multi-faceted Dementia Training Programme (DTP) for dyads of general practitioners (GPs) and primary care nurses (PCNs), aimed at the implementation of Dutch national dementia guidelines. The objective of this study is to identify successful elements of the DTP and barriers for its implementation. The DTP consisted of two workshops, individual coaching on real-life cases, access to an internet forum, and a computerized clinical decision support system. Two independent researchers interviewed a selected sample of 10 GPs and 12 nurses who participated in the DTP. Interviews were analysed using the grounded theory approach. Analysis revealed three important successful elements of the DTP: learning based on real-life cases, structured protocols and collaboration. Learning based on real-life cases facilitated knowledge and skills sinking in. It made participants understand the importance of early dementia diagnosis and adequate disclosure. Furthermore, it increased awareness to signals of possible dementia and generated insight into possible therapeutic options for dementia patients and their caregivers, thereby reducing the feeling of therapeutic nihilism. The structured diagnostic protocols provided in the DTP, made GPs feel competent to diagnose dementia. Nurses appreciated the fact the protocols gave them a role in diagnostic workup. When collaborating, GPs and nurses felt that they obtained an overall picture of both patient and caregiver, learning from each others views and skills, which improved the quality of the diagnostic and care process. Most GPs stated that they could not perform adequate diagnostic work-up and management without the help of a nurse. Barriers for implementation of primary care dementia guidelines, using the DTP, were the time consuming nature of dementia care, the lack of adequate financial compensation by insurance companies for the care provided and the lack of interdisciplinary collaboration with other health care providers. The DTP's successful elements, learning based on real-life cases, structured protocols, and collaboration, seem to change attitudes, diagnosis and management in primary dementia care. Barriers to implementation of dementia guidelines are lack of time, of financial compensation and of interdisciplinary collaboration. Policy makers could play an important role in overcoming these barriers.