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

Abstract

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.

Dementia and primary care teams: obstacles to the implementation of Portugal’s Dementia Strategy

“…As in our previous studies (Balsinha et al, 2021), four groups of primary care centres within the Lisbon metropolitan area were selected to reflect different socio-economic characteristics.…”

“…In an earlier publications (Balsinha et al, 2021), we explored the role of GPs in dementia care in Portugal and found that GPs contributed little, working alone despite being members of multidisciplinary teams. The provision of dementia care by PNs has been explored in the literature; a recent systematic review identified its potential benefits (e.g., increased patient accessibility to PNs, early recognition and management of cognitive changes, better care management) as well as limitations (e.g., lack of definition of PN roles, inadequate dementia training, time constraints and poor communication with GPs) (Gibson et al, 2020).…”

Educational interventions to improve detection and management of cognitive decline in primary care—An Italian multicenter pragmatic study

“…Since family physicians (FPs) act as gatekeepers of the care pathway, they should have the capacity to detect early cognitive decline, provide information and appropriate referral to specialists, and reduce the use of harmful or ineffective interventions (3). Despite the attention to a timely diagnosis, in Italy and other European countries dementia is underrecognized and under-managed in primary care settings (4)(5)(6), and cognitive decline is often not mentioned in the medical records until it is indicative of a serious condition (7). A previous experience from a study (the REMIND study) in the Health Authority (HA) of Milan in Northern Italy revealed difficulties in the ability of FPs to early recognize cognitive decline and provide appropriate referral to a specialized service.…”

Comment on: Family caregiver assessment in primary care: How to strengthen the healthcare triad?

“…In our face-to-face interviews, 3 the family doctors expressed empathy about caregivers' burden and provided unstructured emotional support, but few considered caregivers to be their primary focus of attention. Their ability to make even minimal assessment of caregivers' needs depended on the patient and caregiver consulting the same family doctor.…”