General practitioners on dementia: tasks, practices and obstacles

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Abstract

The objective of the study was to identify the GPs’ perception of their tasks, their practice and obstacles concerning the diagnosis and management of dementia. Twenty-eight GPs participated in focus-group interviews and completed a questionnaire. The GPs perceived their tasks to diagnose, inform and manage dementia patients and their relatives preferably from an early stage on and in such a way that patients are able to stay at home as long as possible. Nevertheless, the GPs diagnose usually in a more progressed stage. As main reasons for this delay the GPs mentioned diagnostic uncertainty during the early stages, embarrassment to conduct a cognitive examination and communicate the diagnosis, non-consulting patients and a lack of time. A discrepancy was found between the GPs’ views of their tasks and their clinical practice regarding dementia. Important obstacles were reported that can explain the diagnostic delay and may prevent appropriate education of family caregivers in dealing with demented patients such as embarrassment to examine and communicate this condition.

Introduction

The GP (General Practitioner) is often the first physician to be contacted by patients suffering from dementia and in many cases the only physician involved in making the diagnosis [1]. However, population-based screening studies revealed a considerable number of demented patients at home who were not known by their GPs [2], [3], [4]. This may indicate that GPs encounter serious obstacles which delay an accurate diagnosis and may prevent appropriate education of family caregivers in dealing with dementia patients at an early stage.

In the medical literature, there is broad consensus concerning the importance of a thorough assessment of the cognitive and functional ability of suspected patients [5], [6], [7], [8]. Several studies also emphasized the importance of informing on and preparing patients and relatives for the disease progression [9], [10]. Especially family caregivers play a central role in successful disease management and can benefit considerably when receiving disease education and care support [11], [12], [13]. Several guidelines for diagnosis and management of dementia in primary care have been developed that cover these insights [5], [14], [15], [16].

Despite a consensus on the ideal medical practice for demented patients by GPs, conflicting studies were published on obstacles that may prevent such practice by GPs. On the one hand, studies reported on the GPs’ limited unacquaintance with diagnostic criteria, a limited knowledge of dementia symptoms, the infrequent use of cognitive screening tests and outdated understanding of causes of dementia [17], [18], [19], [20], [21]. Research among relatives reported problems such as not receiving comprehensive medical information to understand what was going on as well as a lack of emotional and practical support [22], [23], [24].

On the other hand, studies reaching somewhat different conclusions reported that GPs were able to recognize the key symptoms of dementia and felt that much could be done to improve the quality of life of both patients and carers [25]. Previous studies among relatives also reported that physicians were regarded as very helpful, particularly in such areas as giving and explaining the diagnosis and understanding families’ needs [26].

These conflicting reports raised the interest for the present study. The objectives were to explore the GPs’ perceptions of their tasks, their practice and obstacles in diagnosing and managing dementia.

Section snippets

Methods

Task perceptions, practice and possible obstacles regarding the diagnosis and management of dementia were explored by means of focus-group interviews and a questionnaire. This combined qualitative and quantitative method was used to gain better insight into the actual motives for undertaking or abstaining from medical action [27]. To obtain a wide range of experiences and to allow group discussions with equal contributions of the members, three groups were composed, one with “experts” and two

Results

Twenty-eight of the 30 invited GPs participated. Compared with the Dutch GP population no differences were found on age, sex and practice experience [29]. The participating GPs more often had a solo practice (60% versus 49%). The GPs estimated the yearly incidence on four dementia patients (SD3).

Conclusions

The GPs’ views of their tasks corresponded well with the consensus in the medical literature on what should be done regarding demented patients and their relatives in primary care. Nevertheless, a discrepancy was found with the GPs’ clinical practice. The GPs indicated to undertake action mainly at a more progressed stage, despite the fact that they considered undertaking medical action in an early stage as more appropriate.

Several obstacles were reported that can delay or prevent appropriate

Acknowledgments

This study was funded by the Alzheimer Society Netherlands and the University of Nijmegen. The authors like to thank Annet Wind, GP, MD and member of the task force of the Dutch College of General Practice that developed the national dementia guideline for GPs for her comments on an earlier draft.

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