Dementia Care In General Practice Research Articles

What requirements do primary care physicians have with regard to dementia diagnostics and dementia care? – a survey study among general practitioners in Germany 2022/2023

BackgroundGeneral practice offers good conditions to detect and provide care for dementia-related diseases. Nonetheless, the effectiveness of dementia care in general practice is repeatedly criticised. To date, few studies have attempted to form a comprehensive picture of the status quo of dementia care in general practice that focuses on GP perspectives of experience and action. The aim of this study was to identify potential strengths and weaknesses of GP-based dementia care, by means of combined consideration of relevant care and treatment dimensions (construct of ‘dementia sensitivity’).MethodsThrough an online poll, a total of 4,511 GPs who are active as treatment providers in Baden-Württemberg, Hesse, Rhineland-Palatinate and Saarland were surveyed between September 2022 and January 2023. In addition to the descriptive analysis, a T-test with independent samples was used to identify significant differences between two groups (interval-scaled or metric variables). Pearson’s chi-squared test (χ2) was used to analyze the percentage values. Two levels of significance were tested for (mean difference at p < 0.05 and p < 0.001). In the course of the analysis, there were particular differences with regard to the sociodemographic variables ‘urban vs. rural doctors’ and ‘doctors with geriatric training vs. doctors with no geriatric training’. Therefore, a complete listing of these parameters is given in the tables. In addition, the factor analysis method was employed.ResultsThe respondents consider it important for GPs to provide care and support for dementia patients. The doctors express the desire to offer active support to patients and their family caregivers. At the same time, many GPs experience challenges and difficulties when it comes to practical diagnostic steps (in line with guidelines), the (early) identification of dementia and consistent disease management, including the anticipation of care and treatment needs. Moreover, it appears that a significant proportion of the sample has only limited confidence when it comes to review relevant help and support services. One consistent finding is that some doctors in urban practices who also have geriatric training show substantial increases in knowledge and information with regard to dementia care.ConclusionsIn the light of the findings, it seems particularly advisable to strengthen the geriatric competence of GPs. Moreover, it seems to be essential to ensure that they are better informed about cooperation and support structures in the area of dementia care and better integrated into these.

The provision of dementia care in general practice: practice nurse perceptions of their role

BackgroundPrimary care nurses can assist General Practitioner’s to identify cognition concerns and support patient health self-management for those experiencing cognitive impairment or dementia. This support may lead to more appropriate care and better health outcomes for this group. Consequently, there is a need to identify the role of the primary care nurse in dementia care provision, nurse perceptions of this role and to also understand the barriers and enablers that may influence any current or potential primary care nurse role in dementia care provision.MethodsEight focus groups were conducted with a total of 36 primary care nurses. Data was transcribed verbatim and thematically analysed.ResultsThere was a high level of agreement between primary care nurses that they had a role in provision of dementia care. This role was largely attributed to the strong therapeutic relationship between nurses and patients. However, dementia care provision was not without its challenges, including a perceived lack of knowledge, limited resources and the hierarchical nature of general practice. Three main themes were identified: personal attributes of the primary care nurse; professional attributes of the primary care nurse role and the context of practice. Six sub-themes were identified: knowing the person; overcoming stigma; providing holistic care; knowing what to do; team culture and working in the system.ConclusionsThe findings of this study suggest primary care nurses have a role in dementia care provision and, there is a need to provide support for the nurse to deliver person-centred health care in the context of cognitive impairment. As the demand for good quality primary care for people living with dementia increases, the role of the primary care nurse should be considered in primary care policy discussions. The knowledge gained from this study could be useful in informing dementia training content, to provide better prompts in the health assessment and care planning templates used by primary care nurses to better identify the care needs of people with a cognitive impairment and to develop dementia care guidelines for primary care nurses.

Improving the Quality of Dementia Care in General Practice: A Qualitative Study.

Background: General Practitioners (GPs) play a central role in caring for people with dementia. There is a growing demand for GP-led community-based dementia care, as advocated in the Irish National Dementia Strategy (INDS). However, there is a paucity of research exploring GPs' views on dementia care since publication of the INDS. The aim of this qualitative study is to develop a deeper understanding of how to improve the quality of dementia care in General Practice, explored from the perspective of Irish GPs.Methods: Semi-structured interviews were conducted with GPs. GPs who completed the “Dementia in Primary Care” CPD module at University College Cork in Ireland were purposively recruited. Interviews were audio-recorded, transcribed, and analyzed by thematic analysis.Results: 12 interviews were conducted with 7 female and 5 male participants. Experience in General Practice ranged from 3 to 32 years. Most GPs practiced in mixed urban-rural settings (n = 9) and had nursing home commitments (n = 8). The average interview length was 45 minutes. Six major themes emerged from the data set, including resourcing primary care, addressing disparities in secondary care, community-centered care as patient-centered care, linking a dementia network, universal access to care, and raising public awareness.Conclusion: GPs find dementia care to be a complex and challenging aspect of primary care. While education and training is advocated by GPs, service delivery must be reconfigured. This will necessitate adequate financial resourcing and the restructuring of community-based dementia care services.

Knowledge, attitudes and skills of dementia care in general practice: a cross-sectional study in primary health settings in Beijing, China

BackgroundGeneral practitioners (GPs) play a significant role in dementia care. However, the knowledge and attitudes of them towards dementia care are poorly characterized. The present study aimed to investigate GPs’ knowledge, attitudes and skills of dementia care in primary health settings in Beijing.MethodsA cross-sectional survey was conducted in 27 community health service centers (CHSCs) in Beijing. The GPs’ knowledge, attitudes and skills were assessed utilizing the Alzheimer’s Disease Knowledge Scale (ADKS), Dementia Care Attitude Scale (DCAS) and self-designed questionnaire, respectively.ResultsA total of 341 participants returned the questionnaire. The overall mean score of GPs’ dementia knowledge measured by the ADKS was 21.42 (SD = 2.73) out of 30 (71.4%), GPs’ attitudes to dementia care was 36.25 (SD = 5.12) out of 50 (72.5%), and GPs’ self-confidence on dementia care skills was 53.93 (SD = 9.57) out of 75 (71.9%). GPs’ overall knowledge towards dementia care was limited and the attitudes were generally positive. They had low level recognition of their roles towards dementia care. The majority of GPs believed that dementia care was within a specialist’s domain not that of general practice.ConclusionGPs demonstrate low levels of dementia knowledge and skills, but express generally positive attitudes towards dementia in this study. It is much needed to translate detailed dementia care handbook, and adequate dementia knowledge training for GPs into practice to improve care outcomes for people with dementia in China. In addition, dementia management should be covered in the national basic package of public health services in primary care.

293 Improving the Quality of Dementia Care in General Practice: A Qualitative Study

Abstract Background The prevalence of dementia in Ireland is rising. General Practitioners (GPs) play a central role in caring for people with dementia. There is a growing demand for community-based care, emphasized by the Irish National Dementia Strategy (INDS). The INDS advocates a multidisciplinary, community-based approach to dementia care. However, there is a paucity of research exploring GPs’ views on dementia since publication of the INDS. The aim of the study is to develop a deeper understanding of how to improve the quality of dementia care in General Practice from the perspective of Irish GPs. Methods Semi-structured interviews were conducted with GPs. GPs who completed a continuing professional development module in Cork on dementia in primary care were purposively recruited. Interviews were analyzed thematically. Analysis was iterative and ongoing with data collection. Results 12 (34.3%) GPs agreed to participate. 10 interviews have been conducted to-date. Participants were evenly distributed by sex (5 male, 5 female). Experience in General Practice varied (3-32 years). Most GPs practiced in mixed urban-rural settings (n=8) and had nursing home commitments (n=7). The average interview length was approximately 45 minutes. Three major themes emerged from the data set: factors promoting care in current practice; resistance to care; and recommendations to improve care. Continuity of care, early disease recognition, coding, audit, and coordinated care teams were recognized as factors promoting quality care. Time, funding, access to secondary care, and inadequate community resources hindered care. GPs emphasized the need for coordinated community services, GP education, review of the chronic disease management scheme for GPs, and service standardization in order to improve care. Conclusion GPs find dementia care to be a complex, challenging aspect of primary care. While education and training is advocated by GPs, service delivery also needs to be reconfigured. Dementia needs to be included under chronic disease management in Ireland and services must become standardized.

Behavioural change in primary care professionals undertaking online education in dementia care in general practice.

A challenge facing general practice is improving the diagnosis, management and care of people with dementia. Training and education for primary care professionals about knowledge and attitudes about dementia is needed. Online resources can provide educational opportunities for health professionals with limited access to dementia training. An online educational resource (four modules over 3 h) was designed to assist primary care practitioners to develop a systematic framework to identify, diagnose and manage patients with dementia within their practice. Interviews and questionnaires (knowledge, attitudes, confidence and behavioural intentions), with practice nurses and international medical graduates working in general practices, were used to evaluate the resource. Participants' knowledge, confidence and attitudes about dementia increased after completing the modules. Participants had strong intentions to apply a systematic framework to identify and manage dementia. In post-module interviews, participants reported increased awareness, knowledge and confidence in assessing and managing people with dementia, corroborating the questionnaire results. This project has demonstrated some early changes in clinical behaviour around dementia care in general practice. Promoting the value of applying a systematic framework with colleagues and co-workers could increase awareness of, and participation in, dementia assessment by other primary care professionals within general practices.

Dementia care: the view from general practice.

Now in Swiss Medical Weekly, dementia care in general practice is examined from the perspective of GPs. The study by Giezendanner et al. is important, shining a light on an increasingly pressing area of primary care and identifying gaps in knowledge, confidence and healthcare services.

Better Journeys for People with Dementia in Northern Sydney

Introduction : Dementia is a complex and chronic disease and is currently the second leading cause of death in Australia, three in ten people over the age of 85 and almost one in ten people over 65 have dementia. In Northern Sydney, there is projected growth of 23% in the population of people aged 75 years and older between 2011 and 2021, indicating a substantial increase in the number of people with dementia in the region over the next 6 years. There are a wide range of services available in Northern Sydney for people with dementia and their carers; however access and information about support services has been problematic. Information is often fragmented and difficult to find for consumers and Health Care Professionals. A partnership between Northern Sydney Local Health District (NSLHD), Sydney North Health Network, CCNB Ltd and Alzheimer’s Australia NSW was established to improve the journeys of people with dementia in Northern Sydney. Method : People with dementia (3) and many more carers (20) told us their stories, with key themes from these journeys identified. Over 40 health professionals from across sectors were separately engaged in mapping a number of typical journeys as well as an ideal journey. Gaps and issues were identified and prioritised, with a range of solutions then identified and prioritised. A project plan was implemented by the partnership, including strategies to address identified gaps in information, service access, referral pathways and education. Major project outputs include clarification of referral pathways for General Practitioners, a “Memory Problems?” booklet outlining the range of services available for people with dementia and their carers, distribution of the same across health sectors, government and non-government services throughout the region, a dementia hospital discharge follow–up service commissioned by Sydney North Health Network (SNHN), and a number of education events targeting different groups across the region. Other initiatives in progress being led by SNHN are the development of national quality indicators for dementia care in general practice and a localised dementia pathway for health professionals. Results : A number of typical journeys for people with dementia and their carers have been mapped, highlighting the range of complex interactions experienced and many opportunities to enable better journeys. The impact of the resulting initiatives are being evaluated through a range of indicators including the timing of referrals to memory clinics in patient’s journeys, unplanned hospital admissions for people with dementia and provider satisfaction. Results are expected to be available by the time of the conference. The NSW Agency for Clinical Innovation is undertaking evaluation of the partnership and it's benefits as part of a statewide program for integrating care for older people with complex health needs. Conclusions : This partnership has resulted in implementation of a plan which will have a substantially greater impact than if one organisation had undertaken this work alone. The project outputs are practical, sustainable and are expected to improve the journeys of people with dementia and their carers in Northern Sydney.

Developing an educational intervention on dementia diagnosis and management in primary care for the EVIDEM-ED trial.

BackgroundDementia syndromes are under-diagnosed and under-treated in primary care. Earlier recognition of and response to dementia syndrome is likely to enhance the quality of life of people with dementia, but general practitioners consistently report limited skills and confidence in diagnosis and management of this condition. Changing clinical practice is difficult, and the challenge for those seeking change it is to find ways of working with the grain of professional knowledge and practice. Assessment of educational needs in a practice has the potential to accommodate variations in individual understanding and competence, learning preferences and skill mix. Educational prescriptions identify questions that need to be answered in order to address a clinical problem. This paper reports the development of an educational needs assessment tool to guide tailored educational interventions designed to enhance early diagnosis and management of dementia in primary care, in the Evidence Based Interventions in Dementia in the Community – Early Diagnosis trial.MethodsA multidisciplinary team, including a lay researcher, used an iterative technology development approach to create an educational needs assessment tool, from which educational prescriptions could be written. Workplace learning was tailored to each practice using the educational prescription, and the method was field-tested in five pilot practices.ResultsThe educational prescriptions appeared acceptable and useful in volunteer practices. The time commitment (no more than four hours, spread out at the practice’s discretion) appeared manageable. The pilot group of practices prioritised diagnosis, assessment of carers’ needs, quality markers for dementia care in general practice, and the implications of the Mental Capacity Act (2005) for their clinical practice. The content of the educational needs assessment tool seemed to be comprehensive, in that no new topics were identified by practices in the field trial.ConclusionsThe educational needs assessment tool took into account practitioners’ knowledge of the local health and social care systems, reflected the complexity of the diagnostic and care processes for people with dementia, and acknowledged the complexity of the disease process itself.

AS11-02 - Predictors of institutionalisation in dementia patients - the role of patients’ and caregivers’ gender

Method 390 patients living at home with mild to moderate dementia and their family caregivers were recruited by 129 general practitioners (GPs) for a three-arm cluster-randomized longitudinal study. The IDA-Study (Initiative for dementia care in general practice, www.projekt-ida.de ) was performed between 2005 and 2010 in Germany. Data were recorded by the GPs and the caregivers at baseline and after 12 and 24 months. 357 caregivers could be interviewed at baseline. The predictors for institutionalization were determined by means of binary logistic regression analysis. Study participants The mean age of the dementia patients was 80.3 years (SD = 6.8). 65% suffered mild dementia, 35% had moderate dementia at baseline. 68% of the patients were women. The mean age of the family caregivers was 59.4 years (SD = 13.4); 73% were women. Results Of the 250 evaluable cases who did not die at home during the first two years after baseline, 60 (24%) were institutionalized during this period. Neither the gender of the dementia patients (p = 0.78) nor that of the caregivers (p = 0.12) was a significant predictor for institutionalization in the regression analysis. Admission to a nursing home was significantly more frequent when the caregiver was older, in a city, when more use had been made of relief offers at baseline, and when the caregivers felt more burdened. Conclusion Institutionalization of a dementia patient does not depend on the gender of the dementia patient or on the gender of the caregiver. Factors of the care situation are decisive, especially whether relief offers are used or not.

Wie kann Versorgungsforschung mit der Problematik mehrerer Zielsetzungen bei gesundheitlichen Interventionen umgehen?

Primary health care delivered by general practitioners and health services research are both moving through a field of high-grade complexity. Health services research questions try to highlight certain aspects of care but it has to be understood that these are just artificial sections of an interdependent network. Problems deriving from multiple objectives of health-related interventions and possible ways of dealing with them are presented, using a study on dementia care in general practice. A qualitative-quantitative design including pre and post phases leads to a marked increase of expenditure and duration of a study, but also enhances the applicability of the study results for health policy makers.

Outreach visits to improve dementia care in general practice: a qualitative study

Outreach visits reflect newer developments in adult learning theory, where the learner is actively involved in the session. Previous studies have indicated a positive effect of outreach visits on GPs' behaviour. However, the empirical role of the facilitator in the visits is poorly described. To explore general practitioners' perception of the outcome of a facilitator programme about dementia, in relation to central aspects of the facilitator's communicative role during the visits. Observational studies, and focus group discussions with participating general practitioners (3 groups, 19 participants) as well as with facilitators (4 participants) in Vejle County, Denmark. Facilitators drew both on a 'factual' knowledge of dementia and a more 'experience-based' knowledge when conveying programme messages. They described themselves as 'carriers of experience'. All general practitioners described an outcome of the programme, and all wished to receive a future visit by a facilitator on new topics. The outcome was described not as ground-breaking medical news, but as practical effects in terms of knowledge of dementia, motivation for working with dementia, structured assessment and management of dementia and critical reflection of established practices regarding dementia. Some general practitioners remained critical as to whether this outcome justified the resources used in the programme. The experience-based dialogue was described as central to the outcome as it linked factual knowledge to clinical practice. This study confirms that outreach visits contribute to the integration of factual knowledge in clinical practice, but it also underscores the importance of addressing tacit communicative practices during facilitator visits and their implications for the outcome of the programme.

Methodological problems in dementia research in primary care: a case study of a randomized controlled trial

The emerging UK national research network in neurodegenerative diseases and dementias aims to promote large-scale community-based studies of therapeutic interventions, based in primary care. However, trials in primary care settings can be problematic, a common difficulty being the recruitment of a large enough sample. The article discusses recruitment issues in a multi-centre randomized controlled trial of differing educational approaches to improving dementia care in general practice. Sample size calculations based on community studies of prevalence may be misleading in intervention trials which may recruit practices with atypical demography. Recruitment rates for practitioners in this study were lower than expected. Professionals excluded themselves from the study mainly due to pressures of time and staff shortages, and we detected both ambivalent attitudes to primary care research and a perception that research into dementia care was not a high priority. Evaluation of the quality of care may be perceived as criticism of clinical practice, at a time when general practice is undergoing major administrative and contractual changes. Variations in Research Ethics Committee conditions for approval led to different methods of recruitment of patients and carers into the study, a factor which may have contributed to disparate levels of recruitment across study sites. Patient and carer levels of recruitment were lower than expected and were affected partly by carers' time pressures and other family commitments, but largely by problems in identifying patients and carers in the practices. The development of research potential in primary care is at an early stage and studies reliant on patient recruitment in general practice must allow for multiple obstacles to enrollment. This is particularly relevant for studies of dementia care, where the prevalence of dementia in a demographically average population is low and the incidence very low, compared with other disabilities. Professionals may give dementia low priority in allocating practice time for research projects, and strategies to address this problem are needed.