A Review of Barriers and Enablers to Diagnosis and Management of Persons with Dementia in Primary Care

Abstract

BackgroundWith the rise in the prevalence of dementia disorders and the growing critical impact of dementia on health-care resources, the provision of dementia care has increasingly come under scrutiny, with primary care physicians (PCP) being at the centre of such attention.PurposeTo critically examine barriers and enablers to timely diagnosis and optimal management of community living persons with dementia (PWD) in primary care.MethodsAn interpretive scoping review was used to synthesize and analyze an extensive body of heterogeneous Western literature published over the past decade.ResultsThe current primary care systems in many Western countries, including Canada, face many challenges in providing responsive, comprehensive, safe, and cost-effective dementia care. This paper has identified a multitude of highly inter-related obstacles to optimal primary dementia care, including challenges related to: a) the complex biomedical, psychosocial, and ethical nature of the condition; b) the gaps in knowledge, skills, attitudes, and resources of PWD/caregivers and their primary care providers; and c) the broader systemic and structural barriers negatively affecting the context of dementia care.ConclusionsFurther progress will require a coordinated campaign and significantly increased levels of commitment and effort, which should be ideally orchestrated by national dementia strategies focusing on the barriers and enablers identified in this paper.

Education to Improve Dementia Care:

“…1,3 These challenges may be addressed through the recent development of interprofessional and collaborative care approaches to dementia within the primary care setting. 33 The Primary Care Collaborative Memory Clinic model in which family physician-led memory clinics are embedded in group practice settings provides comprehensive assessment and recommendations for management and continuing shared care with the patient's own Practice improvements were related to improved screening and assessment, particularly as related to the use of the brain map to better differentiate types of dementia, improved recognition of delirium and improved prescribing.…”

“…16 Enhanced training in clinical assessment and access to diagnostic tools have been identified as critical to improving the diagnosis of dementia. 1,3,15 To build capacity for dementia care, a continuing medical education (CME) workshop was developed by family physicians for family physicians with the support of the Ontario College of Family Physicians, Canada. The workshop was adapted from the curriculum of a comprehensive 5-day interprofessional training program designed to develop primary care-based collaborative memory clinics.…”

“…1,3 Studies have also found that physicians have difficulty differentiating types of dementia, 12 lack knowledge of early signs and symptoms of cognitive impairment, 13 and lack confidence in their diagnostic skills. 14,15 They may…”

“…1,2 As many as two-thirds of persons in the community with dementia remain undiagnosed 3 ; the global prevalence rate of undiagnosed dementia has been estimated to be 61%. 4 Delayed diagnosis results in a higher burden of suffering, excessive emergency department (ED) visits and hospitalizations, higher rates of care in hospitals while waiting for more appropriate alternate levels of care (ALC), premature institutionalization, and higher avoidable health care costs.…”

Practice Patterns, Beliefs, and Perceived Barriers to Care Regarding Dementia: A Report from the American Academy of Family Physicians (AAFP) National Research Network

“…Nonetheless, the major reason for the large numbers of patients Ͼ65 years old with undiagnosed dementia is the difficulty in making the diagnosis, especially in its early stages. 9 With the aging of the population, the percent age of the population in North America likely to be diagnosed with dementia is estimated to increase by 49% by 2020 and 172% by 2040. 10 Primary care physicians must learn to care for these patients; thus, it is useful to understand family physicians' current clinical expectations, actions, and needs related to dementia care.…”