Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: a systematic review

Tamar Koch,Steve Iliffe

doi:10.1186/1471-2296-11-52

Abstract

BackgroundThe diagnosis of dementia in primary care is perceived as a problem across countries and systems, resulting in delayed recognition and adverse outcomes for patients and their carers. Improving its early detection is an area identified for development in the English National Dementia Strategy 2009; there are thought to be multiple benefits to the patient, family, and resources by doing this. The aim of this review was to carry out a rapid appraisal in order to inform the implementation of this policy.MethodPublications in English up to August 2009 relating to barriers to the recognition of dementia, were identified by a broad search strategy, using electronic databases MEDLINE, EMBASE, and psycINFO. Exclusion criteria included non-English language, studies about pharmacological interventions or screening instruments, and settings without primary care.ResultsEleven empirical studies were found: 3 quantitative, 6 qualitative, and 2 with mixed methodologies. The main themes from the qualitative studies were found to be lack of support, time constraints, financial constraints, stigma, diagnostic uncertainty, and disclosing the diagnosis. Quantitative studies yielded diverse results about knowledge, service support, time constraints, and confidence. The factors identified in qualitative and quantitative studies were grouped into 3 categories: patient factors, GP factors and system characteristics.ConclusionMuch can still be done in the way of service development and provision, GP training and education, and the eradication of stigma attached to dementia, to improve the early detection and management of dementia. Implementation of dementia strategies should include attention to all three categories of barriers. Further research should focus on their interaction, using different methods from studies to date.

Highlights

The diagnosis of dementia in primary care is perceived as a problem across countries and systems, resulting in delayed recognition and adverse outcomes for patients and their carers
Much can still be done in the way of service development and provision, General Practitioners (GPs) training and education, and the eradication of stigma attached to dementia, to improve the early detection and management of dementia
The aim of this review is to systematically investigate current evidence about the barriers to dementia diagnosis in primary care, in order to address and overcome them

Summary

Introduction

The diagnosis of dementia in primary care is perceived as a problem across countries and systems, resulting in delayed recognition and adverse outcomes for patients and their carers. Improving its early detection is an area identified for development in the English National Dementia Strategy 2009; there are thought to be multiple benefits to the patient, family, and resources by doing this. From a Global Burden of Disease perspective it contributes 11.2% of all This changing demography challenges governments and other health care providers to develop and improve services to people with dementia, with an emphasis on earlier diagnosis, provision of support in the community, and the role of primary care services [5,6]. Position does not necessarily lead to action, and there appear to be barriers to recognition of dementia in primary care

Objectives

Methods

Results

Discussion

Conclusion