Health-Care Delivery for Older People with Dementia in Primary Care

Balsinha, Conceição; Gonçalves-Pereira, Manuel; Iliffe, Steve; Freitas, José; Grave, Joana

doi:10.1007/978-3-030-10814-4_23

Cited by 15 publications

(15 citation statements)

References 79 publications

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“…Portuguese GPs are allowed to prescribe anti-dementia medication, but patients are only reimbursed with neurologists' or psychiatrists' prescriptions. Patient access to these specialists in the NHS is mainly limited by waiting lists, mandatory referral by GPs and, in some cases, travelling long distances (Balsinha et al, 2019). Although Portuguese GPs are 'specialists' strictly speaking, the use of this term is commonly applied to doctors other than GPs.…”

Section: Introductionmentioning

confidence: 99%

What is the present role for general practitioners in dementia care? Experiences of general practitioners, patients and family carers in Portugal

et al. 2020

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Background Governments are being challenged to integrate at least part of dementia care into primary care. However, little is known about the current role of general practitioners (GPs) regarding dementia care, especially in countries that do not have dementia strategies in place. The aim of this study was to explore the experiences of GPs, persons with dementia and their family carers in Portuguese primary care settings, to better understand GPs’ contribution to dementia care. Methods A qualitative interview study of participants recruited from six practices in different social contexts within the Lisbon metropolitan area was carried out. Purposive sampling was used to recruit GPs, persons with dementia and carers. Interviews with GPs explored dementia care comprehensiveness, including satisfactory and challenging aspects. Interviews with patients and carers explored the experience of talking to GPs about cognitive impairments and related difficulties and the type of help received. Thematic analysis of interview transcripts was carried out using the framework approach. Results Five major themes were identified: GPs have a limited contribution to dementia care, the case of advanced dementia, doctor–patient relationships, doctor–carer relationships and management of chronic conditions other than dementia. Conclusion General practitioners seemed to contribute little to dementia care overall, particularly regarding symptom management. The exception was patients with advanced stages of dementia, given that specialists no longer followed them up. Remarkably, GPs seemed to be alone within primary care teams in providing dementia care. These findings strongly suggest that Portuguese primary care is not yet prepared to comply with policy expectations regarding the management of dementia.

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Section: Introductionmentioning

confidence: 99%

What is the present role for general practitioners in dementia care? Experiences of general practitioners, patients and family carers in Portugal

et al. 2020

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“…Deverá discutir-se a sua aplicabilidade nacional, nomeadamente quanto ao papel dos cuidados de saúde primários. 23,60 O acesso atempado e a utilização adequada dos serviços na comunidade poderão diminuir as necessidades não-cobertas de pessoas com demência e dos seus cuidadores informais, bem como a sobrecarga das famílias.…”

Section: Implicações Do Estudo Em Termos De Políticas E Serviçosunclassified

Necessidades de Cuidados e Recurso aos Serviços na Demência: Avaliação Inicial da Coorte Portuguesa no Estudo Actifcare

et al. 2019

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Introduction: People with dementia and their relatives should have timely access to formal care in the community. The EU-Actifcare project analysed access to and use of formal services, as related to unmet needs for care. We describe the cohort study implementation and baseline results in Portugal, with a focus on needs for care and service use assessments.Material and Methods: Our convenience sample consisted of 66 dyads of community-dwelling people with mild to moderate dementia and no significant use of formal services, and their informal carers. Measures included the Camberwell Assessment of Need for the Elderly and Resources Utilization in Dementia.Results: People with dementia had unmet needs (mean 1.1; SD 1.7), mainly regarding company (23%), psychological distress (20%), and daily activities (14%). Family caregivers spent 150 minutes/day (median) providing support, and 44% had psychological distress unmet needs. Problems with access to or use of formal services, when present, were frequently due to attitudes or lack of knowledge of any or both members of the dyad.Discussion: The recruitment process was challenging, since the inclusion criteria were restrictive. Not claiming generalizability, we recruited a typical sample of Portuguese people with mild to moderate dementia and no significant formal community support. Levels and type of unmet needs found in some participants would call for formal support, were it not for problems regarding access or use.Conclusion: There are difficulties regarding timely access and effective use of formal care in dementia, along with relevant unmet needs.

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“…General practitioners (GPs) play a paramount role in dementia care [1][2][3][4][5][6]. They are often the first point of contact for patients with dementia (PwD) and play a key part in both diagnosis [7][8][9] and management of the disease [1,[10][11][12]]. Despite the central role of GPs in the care of dementia, primary care-based interventions to assist GPs and PwD remain rare.…”

Section: Introductionmentioning

confidence: 99%

Recruiting general practitioners and patients with dementia into a cluster randomised controlled trial: strategies, barriers and facilitators

Lech

O’Sullivan

Wellmann

et al. 2021

BMC Med Res Methodol

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Background Recruitment of general practitioners (GPs) and their patients is reported as one of the most challenging steps when undertaking primary care research. The present paper describes the recruitment process of a cluster randomised controlled trial (cRCT) aiming to improve dementia care in the primary care setting. Methods Recruitment data was analysed descriptively using frequency tables to investigate comparisons of recruitment rates and results of different recruitment strategies as well as reasons for participation and non-participation of GPs, patients with dementia (PwD) and their caregivers. Results Over a period of 23 months, N = 28 GPs were successfully included in the cRCT. This represents an overall recruitment rate of 4.6%. The most efficient strategy in terms of high response and low labour-intensity involved the dissemination of calls for participation in a GP research network. Most frequently reported reasons for GP’s participation were Improvement of patient’s well-being (n = 22, 79%) followed by Interest in dementia research (n = 18, 64%). The most common reasons for non-participation were Lack of time (n = 71, 34%) followed by Not interested in participation (n = 63, 30%). On a patient level, N = 102 PwD were successfully recruited. On average, each GP referred about n = 7 PwD (range: 1–17; mdn = 6; IQR = 3.5) and successfully recruited about n = 4 PwD (range: 1–11; mdn = 3; IQR = 3.5). Conclusion First, our findings propose GP research networks as a promising strategy to promote recruitment and participation of GPs and their patients in research. Second, present findings highlight the importance of including GPs and their interests in specific research topics in early stages of research in order to ensure a successful recruitment. Finally, results do not support cold calls as a successful strategy in the recruitment of GPs. Trial registration The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413). Registered 01 April 2019.

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Health-Care Delivery for Older People with Dementia in Primary Care

Cited by 15 publications

References 79 publications

What is the present role for general practitioners in dementia care? Experiences of general practitioners, patients and family carers in Portugal

What is the present role for general practitioners in dementia care? Experiences of general practitioners, patients and family carers in Portugal

Necessidades de Cuidados e Recurso aos Serviços na Demência: Avaliação Inicial da Coorte Portuguesa no Estudo Actifcare

Recruiting general practitioners and patients with dementia into a cluster randomised controlled trial: strategies, barriers and facilitators

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