Age and Ageing Advance Access originally published online on July 22, 2004
Age and Ageing 2004 33(5):461-467; doi:10.1093/ageing/afh140
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Age and Aging Vol. 33 No. 5 © British Geriatrics Society 2004; all rights reserved
Research Paper |
General practitioners' knowledge, confidence and attitudes in the diagnosis and management of dementia
1 Centre for Social Research on Dementia, Department of Applied Social Sciences, University of Stirling, Stirling, Scotland, UK
2 Department of Psychology, University of Stirling, Stirling, Scotland, UK
3 Department of Primary Care and Population Sciences, RFUCLMS, Rowland Hill Street, London NW3 2PF, UK
4 Bradford Dementia Group, School of Health Studies, University of Bradford, Bradford, UK
5 Social Care Institute for Excellence, Goldings House, 2 Hays Lane, London, UK
6 School of Nursing, Midwifery and Health Studies, Faculty of Health Studies, University of Wales, Bangor, UK
Address correspondence to: S. Iliffe. Fax: (+44) 20 7830 2339. Email: s.iliffe{at}pcps.ucl.ac.uk
Abstract
Objective: to measure general practitioners' knowledge of, confidence with and attitudes to the diagnosis and management of dementia in primary care.
Setting: 20 general practices of varying size and prior research experience in Central Scotland, and 16 similarly varied practices in north London.
Participants: 127 general practitioners who had volunteered to join a randomised controlled trial of educational interventions about dementia diagnosis and management.
Methods: self-completion questionnaires covering knowledge, confidence and attitudes were retrieved from practitioners prior to the educational interventions.
Results: general practitioners' knowledge of dementia diagnosis and management is good, but poor awareness of its epidemiology leads to an over-estimate of caseload. Knowledge of local diagnostic and support services is less good, and one third of general practitioners expressed limited confidence in their diagnostic skills, whilst two-thirds lacked confidence in management of behaviour and other problems in dementia. The main difficulties identified by general practitioners were talking with patients about the diagnosis, responding to behaviour problems and coordinating support services. General practitioners perceived lack of time and lack of social services support as the major obstacles to good quality care more often than they identified their own unfamiliarity with current management or with local resources. Attitudes to the disclosure of the diagnosis, and to the potential for improving the quality of life of patients and carers varied, but a third of general practitioners believed that dementia care is within a specialist's domain, not that of general practice. More experienced and male general practitioners were more pessimistic about dementia care, as were general practitioners with lower knowledge about dementia. Those reporting greater difficulty with dementia diagnosis and management and those with lower knowledge scores were also less likely to express attitudes endorsing open communication with patient and carer.
Conclusion: educational support for general practitioners should concentrate on epidemiological knowledge, disclosure of the diagnosis and management of behaviour problems in dementia. The availability and profile of support services, particularly social care, need to be enhanced, if earlier diagnosis is to be pursued as a policy objective in primary care.
Keywords: dementia, diagnosis, communication, social care, continuing medical education, elderly
Received September 25, 2003; Revision received February 12, 2004. accepted in revised form February 12, 2004.
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