Effectiveness of educational interventions in improving detection and management of dementia in primary care: cluster randomised controlled study

Downs, Murna; Turner, Stephen; Bryans, M; Wilcock, Jane; Keady, John; Levin, Enid; O’Carroll, Ronan E.; Howie, Kate; Iliffe, Steve

doi:10.1136/bmj.332.7543.692

Cited by 178 publications

(236 citation statements)

References 19 publications

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“…We know that evidence based practice protocols can enhance detection rates in primary care (Downs et al, 2006), and there is growing evidence that communication skills in talking to people with dementia about dementia can be improved (Bamford et al, 2007b). 'Best practice' care pathways that require use of brief cognitive function tests to facilitate detection and earlier diagnosis should be part of service commissioning, and remunerated as such.…”

Section: Improving the Detection Of Dementia In Primary Carementioning

confidence: 99%

Primary care and dementia: 1. diagnosis, screening and disclosure

Iliffe

Robinson

Brayne

et al. 2009

Int J Geriat Psychiatry

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168

154

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SUMMARYObjectives To write a narrative review of the roles of primary care practitioners in caring for people with dementia in the community. Methods The systematic review carried out for the NICE/SCIE Guidelines was updated from January 2006, Cochrane Reviews were identified, and other publications found by consultation with experts. Results The insidious and very variable development of dementia syndromes makes recognition of the syndrome problematic in primary care. Dementia is probably under-diagnosed and under treated with an estimated 50% of primary care patients over 65 not diagnosed by their primary care physicians. This problem of under-diagnosis is probably not due to lack of diagnostic skills, but rather to the interaction of case-complexity, pressure on time and the negative effects of reimbursement systems. Primary care physicians often over-estimate the prevalence of dementia syndromes, but in some countries may also overestimate the prevalence of vascular dementia compared with Alzheimer's disease. Diagnosis is a step-wise process which can be aided by use of a cognitive function test, of which there are a number suitable for primary care use. Evidence based practice protocols can enhance detection rates in primary care, and there is growing evidence that communication skills in talking to people with dementia about dementia can be improved. Nevertheless there are multiple obstacles to bringing recognition forward in time, both in public awareness and professional understanding of the early changes in dementia. Conclusions There is insufficient evidence of benefit to justify population screening in primary care but earlier recognition of people with dementia syndrome is possible within primary care. The diagnosis of dementia is a shared responsibility between generalist and specialist disciplines. Primary care physicians should explore patients' ideas and concerns around their symptoms prior to referral and tentatively discuss possible diagnoses. Once the diagnosis has been confirmed, the primary care physician should provide both practical and emotional support to allow the patient and their family to come to terms with living with dementia, and refer them for additional psychosocial support if required.

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Section: Improving the Detection Of Dementia In Primary Carementioning

confidence: 99%

Primary care and dementia: 1. diagnosis, screening and disclosure

Iliffe

Robinson

Brayne

et al. 2009

Int J Geriat Psychiatry

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168

154

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“…10,57 Improving equity of access to good quality medical care is underpinned by, for example, the Care Quality Commission, 58 Healthcare Improvement Scotland, 59 and the National Dementia Strategies for England 60 and Scotland. 61 Educational interventions developed for general practices may be one potential strategy, as they have already been shown to improve detection of dementia, 62 and trials are underway to improve overall clinical management and adherence to management guidelines. 63 The findings suggest that further research should focus on the unique clinical and organisational challenges to the commissioning and administration of routine medical care for comorbid vascular diseases in people with dementia, especially those who are living in care homes.…”

mentioning

confidence: 99%

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Connolly

Campbell²,

Gaehl³

et al. 2013

Br J Gen Pract

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BackgroundVascular diseases contribute to the causation and progression of clinical dementia. AimTo evaluate the quality of medical care for vascular diseases provided to people with dementia, the patient and practice characteristics that influence quality, and to compare care with that provided to those without dementia. Design and settingObservational, cross-sectional review of primary care records of people with dementia from 52 general practices from five primary care trusts in the UK, and comparison with publicly available summary data on patients without dementia. MethodA total of 700 patients with ≥1 diagnosed vascular disease or risk factor were identified from dementia registers. Quality of care was measured on 30 indicators from the UK Quality and Outcomes Framework (QOF) for hypertension, coronary heart disease, stroke, diabetes mellitus, atrial fibrillation, heart failure, and smoking. Overall quality of vascular care was calculated for each patient with dementia. ResultsLevel of care received by people with dementia was significantly lower compared with those without dementia for 22 of 30 (73%) indicators; most notably for measurement processes such as peripheral pulses check and neuropathy testing for diabetes, and cholesterol measures for stroke. Among people with dementia, women, those in care homes, and those with fewer comorbid physical conditions and medications were associated with lower scores for overall quality of vascular care. ConclusionThe quality of medical care provided to people with dementia with regard to vascular diseases is not concordant with quality, as defined by the QOF. Research is needed to improve access to high-quality care.

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“…Seminar-based interventions seem unable to demonstrate any improvement in the diagnostic or management outcomes measured (23). Conversely, facilitated educational strategies were able to improve knowledge and self-directed learning (24), and practice-based workshops and decision-support software improved the detection rate but not the management of dementia (25). In addition, one study trialled three interventions designed to improve primary care practitioners' adherence to guidelines (26).…”

Section: Enhancing Skillsmentioning

confidence: 99%