Primary Care Practitioner Perspectives on the Role of Primary Care in Dementia Diagnosis and Care

Abstract

ImportanceAlthough the barriers to dementia care in primary care are well characterized, primary care practitioner (PCP) perspectives could be used to support the design of values-aligned dementia care pathways that strengthen the role of primary care.ObjectiveTo describe PCP perspectives on their role in dementia diagnosis and care.Design, Setting, and ParticipationIn this qualitative study, interviews were conducted with 39 PCPs (medical doctors, nurse practitioners, and doctors of osteopathic medicine) in California between March 2020 and November 2022. Results were analyzed using thematic analysis.Main Outcomes and MeasuresOverarching themes associated with PCP roles in dementia care.ResultsInterviews were conducted with 39 PCPs (25 [64.1%] were female; 16 [41%] were Asian). The majority (36 PCPs [92.3%]) reported that more than half of their patients were insured via MediCal, the California Medicaid program serving low-income individuals. Six themes were identified that convey PCPs’ perspectives on their role in dementia care. These themes focused on (1) their role as first point of contact and in the diagnostic workup; (2) the importance of long-term, trusting relationships with patients; (3) the value of understanding patients’ life contexts; (4) their work to involve and educate families; (5) their activities around coordinating dementia care; and (6) how the care they want to provide may be limited by systems-level constraints.Conclusions and RelevanceIn this qualitative study of PCP perspectives on their role in dementia care, there was alignment between PCP perspectives about the core values of primary care and their work diagnosing and providing care for people living with dementia. The study also identified a mismatch between these values and the health systems infrastructure for dementia care in their practice environment.

Perceptions and outcomes of an embedded Alzheimer Society First Link Coordinator in rural primary health care memory clinics

“…The FLC involvement in the clinic benefited team members by allowing them to focus on their roles knowing that caregivers were being supported, and by learning about available community and Alzheimer Society services. Rural family physicians recognize caregivers’ need for education and emotional support and see this as part of their role [ 21 , 53 ] but like many primary care physicians they lack the resources and time needed to provide ongoing care management and support [ 22 , 24 ]. Heintz et al [ 22 ] assert that within collaborative care teams, dementia care managers, which share many facets of the FLC role, can ensure that PLWD and caregivers have access to the information and support needed to obtain services, while also improving primary care providers’ work lives and sense of competence.…”

“…Bayly et al [ 3 ] conducted a review of dementia service availability in rural areas that identified strategies to address service use barriers, including a point of contact to assist in accessing services that matched individual needs. Primary care physicians often lack adequate time and reimbursement systems needed to manage all the complexities of dementia care such as education and care coordination [ 21 , 22 ].…”

Error in Title

“…In the Original Investigation titled “Primary Care Practitioner Perspectives on the Role of Primary Care in Dementia Diagnosis and Care,” 1 published September 28, 2023, “practitioner” was misspelled in the title. This article has been corrected.…”