Background: Improving quality of care for people with dementia is a high priority. Considerable resources have been invested in financial incentives, guideline development, public awareness and educational programmes to promote earlier diagnosis and better management.
Objectives: Evaluating family physicians’ concordance with guidelines on diagnosis and management of people with dementia, from...
(Publisher abstract)
Background: Improving quality of care for people with dementia is a high priority. Considerable resources have been invested in financial incentives, guideline development, public awareness and educational programmes to promote earlier diagnosis and better management.
Objectives: Evaluating family physicians’ concordance with guidelines on diagnosis and management of people with dementia, from first documentation of symptoms to formal diagnosis.
Method: Analysis of medical records of 136 people with dementia recruited by 19 family practices in NW London and surrounding counties.
Results: Practices invited 763 people with dementia to participate, 167 (22%) agreed. Complete records were available for 136 (18%). The majority of records included reference to recommended blood tests, informant history and caregiver concerns. Presence or absence of symptoms of depression, psychosis, other behavioural and psychological symptoms of dementia, and cognitive function tests were documented in 30%–40% of records. Documentation of discussions about signs and symptoms of dementia, treatment options, care, support, financial, legal and advocacy advice were uncommon. Comparison of these findings from a similar study in 2000–2002 suggests improvements in concordance with blood tests, recording informant history, presence or absence of depression or psychosis symptoms. There was no difference in documenting cognitive function tests. Immediate referral to specialists was more common in the recent study.
Conclusion: Five years after UK dementia guidelines and immediately after the launch of the dementia strategy, family physicians appeared concordant with clinical guidelines for dementia diagnosis (other than cognitive function tests), and referred most patients immediately. However, records did not suggest systematic dementia management.
(Publisher abstract)
Subject terms:
diagnosis, management, dementia, general practitioners, health care, standards;
Journal of Integrated Care, 17(4), August 2009, pp.3-11.
Publisher:
Emerald
This paper reviews the scale of the problem of dementia and its likely impact on services in the near future. It discusses some of the key recommendations of the National Dementia Strategy and explores debates about dementia advisors, economic modelling of innovative dementia services and the need for widespread training in the recognition of and response to dementia. Finally, it offers
This paper reviews the scale of the problem of dementia and its likely impact on services in the near future. It discusses some of the key recommendations of the National Dementia Strategy and explores debates about dementia advisors, economic modelling of innovative dementia services and the need for widespread training in the recognition of and response to dementia. Finally, it offers an approach to changing professional practice that is based on adult learning principles and workplace-based reflective practice.
Subject terms:
social care provision, training, commissioning, dementia, diagnosis, early intervention, health care;
Aging and Mental Health, 13(2), March 2009, pp.155-161.
Publisher:
Taylor and Francis
This study aimed to determine general practitioners' concordance with clinical guidelines on the diagnosis and management of patients with dementia. The research used an unblinded, cluster randomized pre-test-post-test controlled trial involving 35 practices in the UK. Patients with a diagnosis of probable or confirmed dementia were identified in practices, and permission sought from the older...
This study aimed to determine general practitioners' concordance with clinical guidelines on the diagnosis and management of patients with dementia. The research used an unblinded, cluster randomized pre-test-post-test controlled trial involving 35 practices in the UK. Patients with a diagnosis of probable or confirmed dementia were identified in practices, and permission sought from the older person and/or their carer to study the medical records of these patients. Medical records were reviewed using a data extraction tool designed for the study and based on published guidelines, and unweighted scores for diagnostic concordance and management concordance were calculated. Four hundred and fifty records of patients aged 75 and over with a diagnosis of dementia were reviewed and it was found that: only 4% of cases were identified first in secondary care; two-thirds of those identified in primary care were referred immediately; about one-third identified had informant history and blood tests documented at the Index consultation and one-fifth underwent cognitive function testing. The records analysed in this study came from a period before the Quality Outcomes Framework and show that the documentation in primary care of the diagnostic process in dementia syndromes is good, although there were significant gaps, particularly around depression case-finding. Information about management processes were less evident in the records.
Subject terms:
primary care, dementia, diagnosis, general practitioners;
Dementia: the International Journal of Social Research and Practice, 5(3), August 2006, pp.327-338.
Publisher:
Sage
Psychosocial interventions are emerging as potentially important therapies for primary care, partly to fill a therapy ‘vacuum’ and partly because the evidence base for their effectiveness is growing. They can be labour-intensive and their effectiveness depends on the skills of those working with people with dementia. This creates an immediate problem, since the workforce necessary to extend...
Psychosocial interventions are emerging as potentially important therapies for primary care, partly to fill a therapy ‘vacuum’ and partly because the evidence base for their effectiveness is growing. They can be labour-intensive and their effectiveness depends on the skills of those working with people with dementia. This creates an immediate problem, since the workforce necessary to extend psychosocial interventions beyond innovative schemes does not exist. The existing workforce in health and social care in the UK is already too small to implement all of the changes required by the National Service Framework for Older People and National Service Framework for Mental Health. This has clear implications for the labour-intensive work of dementia care. If the job categories cannot expand as fast as is needed, the tasks of dementia care will have to be redistributed, suggesting that skills will have to be shared and transferred between different disciplines. The question for service commissioners and providers is: how can smarter working be achieved? This article attempts to answer this question with a qualitative study in general practice settings and with specialist informants. A triangulation approach to data collection was used, involving nominal groups, individual interviews and participant observation. We identified five skills that appear key in primary care: pattern recognition; deductive synthesis to reduce uncertainty; dialogue and disclosure; disability perspectives; and case management with shared care. The paucity of understanding of psychosocial interventions across disciplines who offer dementia care in the community is, we suggest, a major problem for those attempting to deploy such interventions in primary care settings. The pervasive tendency to frame the tasks of dementia care in terms of a medical management model brings responses that can undermine the view that people with dementia may in fact have a tractable disability. We use our findings to suggest solutions to this problem.
Subject terms:
intervention, primary care, psychosocial approach, training, dementia, general practitioners;
Dementia: the International Journal of Social Research and Practice, 4(1), February 2005, pp.73-85.
Publisher:
Sage
This study reports upon the identification of barriers to the recognition of and response to dementia in primary care as perceived by general practitioners and highlights areas of information and training need. The study took a qualitative approach involving group work with 144 general practitioners in three purposively selected settings using adapted nominal group data collection methods. Six...
This study reports upon the identification of barriers to the recognition of and response to dementia in primary care as perceived by general practitioners and highlights areas of information and training need. The study took a qualitative approach involving group work with 144 general practitioners in three purposively selected settings using adapted nominal group data collection methods. Six key themes were identified that explain the complexity of dementia diagnosis and management: (1) the pre-eminence of problem-solving over differential diagnosis as a working style; (2) the existence of gaps in support services; (3) problems of confidentiality; (4) the importance of ‘red flags’; (5) rules governing disclosure of diagnoses; and (6) heuristics for distinguishing dementia from normal ageing or other pathologies. In addition the practitioners identified principles governing medication use, issues around carers’ needs and implications for professional education. The National Service Framework for Older People emphasizes the need for early detection and diagnosis of dementia in primary care. This study identified barriers to be overcome by targeted educational interventions and through service provision. There is an uneven geographical distribution of support and diagnostic services and a lack of awareness of how to access these, and this needs addressing. A stepwise educational method is recommended as opposed to promotion of a formal syllabus.
Subject terms:
medication, primary care, standards, ageing, confidentiality, dementia, demographics, diagnosis, disclosure, general practitioners, health education;
Journal of Dementia Care, 12(4), July 2004, pp.16-17.
Publisher:
Hawker
Identifies twelve competencies needed by professionals along the dementia care pathway which have been developed by the Centre for Ageing Population Studies at the Royal Free & UCL Medical school. They are generic skill that can be shared across disciplines as core competencies usable by doctors, nurses and social workers.
Identifies twelve competencies needed by professionals along the dementia care pathway which have been developed by the Centre for Ageing Population Studies at the Royal Free & UCL Medical school. They are generic skill that can be shared across disciplines as core competencies usable by doctors, nurses and social workers.
Subject terms:
models, multidisciplinary services, primary care, staff, training, dementia;
Journal of Dementia Care, 12(3), May 2004, pp.16-17.
Publisher:
Hawker
Recent legislation obliges Primary Care Trusts to implement 'shared care' protocols - collaboration between GPs and hospital specialists - for people with dementia. Explains 'shared care' and suggests how PCTs should proceed.
Recent legislation obliges Primary Care Trusts to implement 'shared care' protocols - collaboration between GPs and hospital specialists - for people with dementia. Explains 'shared care' and suggests how PCTs should proceed.
Subject terms:
models, older people, primary care trusts, standards, dementia, general practitioners, health professionals;
Primary care nurses have a key role to play in identifying and supporting people with dementia. Looks at how primary health care nurses could benefit from improved training in the skills necessary to provide effective support.
Primary care nurses have a key role to play in identifying and supporting people with dementia. Looks at how primary health care nurses could benefit from improved training in the skills necessary to provide effective support.
Subject terms:
nurses, older people, primary care, training, assessment, Alzheimers disease, care management, dementia, diagnosis;