General practitioner’s clinical practices, difficulties and educational needs to manage Alzheimer’s disease in France: analysis of national telephone-inquiry data

Abstract

BackgroundThe literature has emphasized the role of general practitioners (GPs) in caring for Alzheimer’s disease (AD) patients. Within the framework of the French national AD plan, an inquiry was undertaken to identify the clinical practices, difficulties and training needs of GPs managing this pathology.MethodsA random sample from a representative national listing of continental French GPs following ≥1 AD patients comprised the study population. Participants completed a standard questionnaire on their clinical practices, difficulties and educational needs for AD management. Feeling insufficiently trained was subjected to univariate and multivariate analyses.ResultsA minority of the 974 respondents declared using questionnaires in their diagnostic evaluation (15.2%), told the patient the diagnosis (8.2%) and was aware of the national recommendations for AD (41.9%). Behavioral disorders represented the most common (73.5%) problem encountered, while half of the GPs considered management of comorbidities easy roles to fulfill. In comparison, coordination of care and assistance did not seem to be a primary problem. A score was calculated, attributing 1 point to each of the following items: need for further education in terms of communications with the family, with patients, disclosing the diagnosis, and non-drug treatments. The factors linked to feeling insufficiently trained for 3 or 4 of the 4 items were: female sex; not involved in educational programs (for parents/family and patients) and no activity related to training medical students.ConclusionsOur study identified gaps in French GP training concerning AD diagnosis practices and diagnosis announcement. GPs seemed aware of their educational needs and described difficulties in managing behavioral disorders. Our findings enabled the definition of policy priorities to provide training and disseminate information.

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

“…However, we know that the diagnostic rates of dementia, although improving, are low . Furthermore, although the majority of people with dementia wish to know the diagnosis, GPs can be reluctant to fully disclose it . Secondly, GPs may be reluctant to initiate a conversation about BPSD unless they feel comfortable giving practical advice to family caregivers on managing BPSD, something many GPs struggle with .…”

“…71 Furthermore, although the majority of people with dementia wish to know the diagnosis, 72 GPs can be reluctant to fully disclose it. 12,73,74 Secondly, GPs may be reluctant to initiate a conversation about BPSD unless they feel comfortable giving practical advice to family caregivers on managing BPSD, something many GPs struggle with. 12 From the findings of this review, inappropriate antipsychotic prescribing appears to be a relevant and worthwhile behaviour to target.…”

Communicating a diagnosis of dementia: A systematic mixed studies review of attitudes and practices of health practitioners

“…Greater likelihood of telling the diagnosis was associated with the practitioner being male (Somme et al, 2013, Cody et al, 2002 and younger (Somme et al, 2013, Tarek et al, 2009, Downs et al, 2002, or working in a practice with two or more practitioners (Van Hout et al, 2006). Two studies reported contradictory findings on how severity of dementia related to whether the diagnosis was told.…”

Effect of a dementia education intervention on the confidence and attitudes of general practitioners in Australia: a pretest post-test study

“…It is estimated that one-third of GPs lack confidence in their diagnostic skills, while two-thirds lack confidence in the management of behaviours associated with dementia,7 or feel they have little or nothing to offer patients presenting with dementia,13 with a third of GPs failing to routinely disclose the diagnosis 7 14 15. Similarly, pessimism surrounding dementia prognosis, and inability to offer curative treatment16 may lead to an attitude of ‘therapeutic nihilism’ among GPs,7 11 which reflects a biomedical definition of treatment and an ethos centred around curing people,16 while simultaneously ignoring therapeutic interventions that may benefit people with dementia and their carers 17–19…”

“…While social psychological theory suggests a relationship between perceptions of self-efficacy, effort and avoidance,22 GPs hesitancy to diagnose dementia may not be explicit. Rather it may manifest in a reluctance to formalise a diagnosis or preferentially treat co-occurring conditions for which treatment options are available,10 23 referring on because of limited treatment options,24 questioning the (traditional) role of the GP in treating dementia25 or having insufficient resources 15…”