The identification of barriers to the recognition of,and response to,dementia in primary care using a modified focus group approach

Abstract

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.

Keywords

diagnosis general practice heuristics qualitative methods

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References

Alzheimer’s Disease Society . (1995). Managing dementia in the community. London: Alzheimer’s Disease Society .

Audit Commission . (2000). Forget me not 2000. London: HMSO .

Audit Commission . (2002). Forget me not 2002: Developing mental health services for older people in England. London: Audit Commission .

Brown, J. , Lent, B. , & Sas, G. (1993). Identifying and treating wife abuse . Family Practice, 36(2), 185-191 .

De Lepeleire, J. , & Heyrman, J. (1999). Diagnosis and management of dementia in primary care at an early stage: The need for a new concept and an adapted structure . Theoretical Medicine & Bioethics, 20(3), 215-228 .

Department of Health . (2001). National service framework for older people. London: Department of Health .

Downs, M. , Cook, I. , Rae, C. , & Collins, K.E. (2000). Caring for patients with dementia: The GP perspective . Aging and Mental Health, 4(4), 301-304 .

Downs, M. , Iliffe, S. , Turner, S. , Bryans, M. , Wilcock, J. , et al. (2002). How can we improve general practitioners’ response to dementia? Journal of Dementia Care, 10(3), 18-19 .

Farquhar, C. , with Das, R. (1999). Are focus groups suitable for ‘sensitive’ topics? In R. Barbour & J. Kitzinger (Eds.), Developing focus group research: Politics, theory and practice (pp. 47-63). London: Sage .

10.

Feltovitch, P.J. , & Barrow, H.S. (1984). Issues of generality in medical problem solving. In H.G. Schmidt & M.L. De Volder (Eds.), Tutorials in problem-based learning (pp. 128-142). Maastricht: Van Gorcum .

11.

Fuat, A. , Hungin, A.P. , & Murphy, J.J. (2003). Barriers to accurate diagnosis and effective management of heart failure in primary care: Qualitative study . British Medical Journal, 326(7382), 196 .

12.

Gallagher, M. , Hares, T. , Spencer, J. , Bradshaw, C. , & Webb, I. (1993). The nominal group technique: A research tool for general practice? Family Practice, 10(1), 76-81 .

13.

Glaser, B.G. , & Strauss, A.L. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago, IL: Aldine .

14.

Guba, E.G. , & Lincoln, Y.S. (1994). Competing paradigms in qualitative research. In N.K. Denzin & Y.S. Lincoln (Eds.), Handbook of qualitative research (pp. 105-117). London: Sage .

15.

Iliffe, S. , Manthorpe, J. , & Eden, A. (2003). Sooner or later? Issues in the early diagnosis of dementia in general practice: A qualitative study . Family Practice, 20(4), 376-381 .

16.

Iliffe, S. , Walters, K. , & Rait, G. (2000). Shortcomings in the diagnosis and management of dementia in primary care: Towards an educational strategy . Aging and Mental Health, 4(4), 286-291 .

17.

Jones, J. , & Hunter, D. (1999). Using the Delphi and Nominal Group Technique in Health Services Research. In C. Pope & N. Mays (Eds.), Qualitative research in health care, 2nd edition (pp. 114-135). London: BMJ Publishing .

18.

Kitzinger, J. (1999). Focus groups with users and providers of health care. In C. Pope & N. Mays (Eds.), Qualitative research in health care, 2nd edition (pp. 20-29). London: BMJ Publishing .

19.

Manthorpe, J. , Iliffe, S. , & Eden, A. (2003a). The implications of the early recognition of dementia for multiprofessional working . Dementia, 2(2), 163-179 .

20.

Manthorpe, J. , Iliffe, S. , & Eden, A. (2003b). Testing Twigg and Atkin’s typology of caring: A study of primary care professionals’ perceptions of dementia care using a modified focus group method . Health & Social Care in the Community, 11(6), 477-485 .

21.

Murphy, E. , Dingwall, R. , Greatbach, D. , Parker, S. , & Watson, P. (1998). Qualitative research methods in health technology assessment: A review of the literature . Health Technology Assessment, 2(16), 71 .

22.

Renshaw, J. , Scurfield, P. , Cloke, L. , & Orrell, M. (2001). General practitioners’ views on the early diagnosis of dementia . British Journal of General Practice, 51(462), 37-38 .

23.

Schon, D. (1987). Educating the reflective practitioner. San Francisco, CA: Jossey Bass .

24.

van Hout, H. , Vernooij-Dassen, M. , Bakker, K. , Blom, M. , & Grol, R. (2000). General practitioners on dementia: Tasks, practices and obstacles . Patient Education & Counselling, 39(2-3), 219-225 .