Dementia care and the role of guideline adherence in primary care: cross-sectional findings from the DemTab study

Abstract

Background General practitioners (GPs) play a key role in the care of people with dementia (PwD). However, the role of the German Dementia Guideline in primary care remains unclear. The main objective of the present study was to examine the role of guideline-based dementia care in general practices. Methods A cross-sectional analysis of data obtained from the DemTab study was conducted. Descriptive analyses of sociodemographic and clinical characteristics for GPs (N = 28) and PwD (N = 91) were conducted. Adherence to the German Dementia Guideline of GPs was measured at the level of PwD. Linear Mixed Models were used to analyze the associations between adherence to the German Dementia Guideline and GP factors at individual (age, years of experience as a GP, frequency of utilization of guideline, perceived usefulness of guideline) and structural (type of practice, total number of patients seen by a participating GP, and total number of PwD seen by a participating GP) levels as well as between adherence to the German Dementia Guideline and PwD’s quality of life. Results Self-reported overall adherence of GPs was on average 71% (SD = 19.4, range: 25–100). Adherence to specific recommendations varied widely (from 19.2 to 95.3%) and the majority of GPs (79.1%) reported the guideline as only partially or somewhat helpful. Further, we found lower adherence to be significantly associated with higher numbers of patients (γ10 = − 5.58, CI = − 10.97, − 0.19, p = .04). No association between adherence to the guideline and PwD’s quality of life was found (γ10 = −.86, CI = − 4.18, 2.47, p = .61). Conclusion The present study examined the role of adherence to the German Dementia Guideline recommendations in primary care. Overall, GPs reported high levels of adherence. However, major differences across guideline recommendations were found. Findings highlight the importance of guidelines for the provision of care. Dementia guidelines for GPs need to be better tailored and addressed. Further, structural changes such as more time for PwD may contribute to a sustainable change of dementia care in primary care. Trial registration The DemTab trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413). Registered 01 April 2019.

Depression in primary care and the role of evidence-based guidelines: cross-sectional data from primary care physicians in Germany

“…First, due to the cross-sectional design we cannot draw conclusions about causal relationships. Second, although the response rate of the present study is comparable to previous primary care research [ 23 , 46 ], the overall response rate was rather low. This leads to limitations in the generalizability of the sample.…”

Depression in primary care and the role of evidence-based guidelines: Cross- sectional data from primary care physicians in Germany

“…However, comparing present sociodemographic characteristics of participating PCPs with previous, representative PCPs samples, demographic characteristics such as age are comparable to some extent (Deselaers, 2021). Further, in comparison to a Berlin and sounding areas based PCP sample, age and sex of the present study are very similar, while years of experience as a PCP are higher among PCPS of the present study (Lech et al, 2021). Further, the present study only focused on two geographical areas (Berlin and the surroundings) and only represents the perspectives of PCPs.…”

Effectiveness of a tablet‐based intervention for people living with dementia in primary care—A cluster randomized controlled trial

“…A detailed overview of the recruitment strategies and rates can be obtained elsewhere. 12 To sum up, PCP were recruited through three recruitment rounds which included the dissemination of advertisements and calls for participation in primary care related networks, cold calls of randomly drawn PCP from a database of the Statutory Health Insurance Physicians in Berlin, and face-to-face recruitment of PCP in their general practices in Berlin. Inclusion criteria for PCP were as follows: (1) operating as PCP, (2) meeting technical requirements (Internet connection), (3) willing to participate in a training, and (4) signed cooperation agreement.…”

“…However, some measures were undertaken and published to ensure the validation of the assessment. 12 For example, originally, the checklists were composed in a dichotomous format (yes/no), but included the category "not applicable". Baseline data analysis of the DemTab Study revealed inconsistencies in the selection of the category "not applicable" resulting in uncertainty how and when this category was chosen by participants.…”

“…11 In our study, we found that people living with dementia visited their PCP on average almost three times over a 3month observation period. 12 Despite empirical evidence highlighting the key role of PCP in dementia healthcare provision, past research has acknowledged challenges in primary care and dementia. [13][14][15] These barriers include lack of knowledge and training in dementia care and lack of time, 16,17 as well as lack of cross-sectorial collaboration.…”