Attitudes to diagnosis and management in dementia care: views of future general practitioners

Abstract

Considerable international governmental support is focused on the timely diagnosis of dementia and post-diagnostic care of people with dementia. Identifying those at high risk of dementia is one approach to timely diagnosis. General practitioners (GPs) are well-placed clinicians in the community to provide both pre- and post-diagnostic dementia care. However, GPs have in the past consistently demonstrated low confidence in both diagnosing dementia and providing care for these complex patients particularly for patients in the post-diagnostic phase. It is currently unclear how future GPs view dementia care. We aimed to evaluate the current attitudes and experiences of future GPs in dementia care and their views on targeting high risk groups. All (n = 513) GP trainees were approached by email to participate in a cross-sectional web and paper-based survey in the North of England. A further reminder was sent out two months after the initial invitation. We received 153 responses (29.8% response rate, 66.7% female, average age 31 (range 25-55 years old). The main difficulties encountered included coordinating supporting services for carers and the person with dementia and responding to co-existing behavioral and psychiatric symptoms. Further education in dementia management was considered to be important by respondents. GP trainees were generally very positive about their future role in caring for people with dementia, particularly in the area of earlier diagnosis via identification of high-risk individuals. Future GPs in one area of England are very positive about their key role in dementia care. In order to facilitate the delivery of high quality, community-based care, work is required to establish core post-diagnostic dementia support services. Further research is needed to identify effective systems to enable accurate assessment and to ensure earlier diagnosis in high-risk groups.

General practitioners' knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia: A mixed‐methods systematic review

“…National strategies developed to address the increased prevalence of dementia have emphasised the role of GPs in successful implementation but dementia care in the community can be challenging . In common with their hospital‐based colleagues, General practitioners find the management of the behavioural and psychological symptoms of dementia (BPSD) particularly difficult …”

“…8,9 In common with their hospital-based colleagues, 10 General practitioners find the management of the behavioural and psychological symptoms of dementia (BPSD) particularly difficult. [11][12][13][14] Behavioural and psychological symptoms of dementia encompass behaviours such as aggression, wandering, sexual disinhibition, agitation, and symptoms such as anxiety, depression, and delusions. Most people with dementia will experience BPSD at some time during their illness.…”

The views of public and clinician stakeholders on risk assessment tools for post-stroke dementia: a qualitative study

“…Further, primary care clinicians themselves are familiar with the process of risk assessment. A survey of primary care physician trainees found that they were also keen to implement a dementia risk assessment strategy to assist in earlier identification 25. However, potential barriers have been identified in previous studies, such as system-related factors (lack of support, time constraints)26 27 and training in dementia,27 which would need to be addressed.…”

What could be the main levers to promote a timely diagnosis of neurocognitive disorders?

“…When assessing the differences in the importance of each benefit and risk among the different groups of respondents we found that GPs appeared less sensitive to the "patient's right to know", "access to medical research" and "initiation of symptomatic drug-treatment"; GPs could thereby be the main target of the previously described recommendation. However, although in some reports GPs are portrayed as barriers to diagnosis, and accused of fatalism regarding NCD, with a "deficit model of GPs behavior and attitudes" [6], a growing body of evidence indicates that the attitude of the majority of GPs is not characterized by diagnostic and therapeutic nihilism and GPs are very positive about their key role in NCD care [34,35]. For many patients, consultations with GPs where they discuss for the first time a cognitive complaint are positive experiences, with feelings of support, familiarity and confidence.…”