General practitioners' knowledge, confidence and attitudes in the diagnosis and management of dementia

Citation

Turner S, Iliffe S, Downs M, Wilcock J, Bryans M, Levin E, Keady J & O'Carroll R (2004) General practitioners' knowledge, confidence and attitudes in the diagnosis and management of dementia. Age and Ageing, 33 (5), pp. 461-467. https://doi.org/10.1093/ageing/afh140

Abstract
Objective: to measure general practitioners' knowledge of, confidence with and attitudes to the diagnosis and managementof dementia in primary care.Setting: 20 general practices of varying size and prior research experience in Central Scotland, and 16 similarly varied practicesin north London.Participants: 127 general practitioners who had volunteered to join a randomised controlled trial of educational interventionsabout dementia diagnosis and management.Methods: self-completion questionnaires covering knowledge, confidence and attitudes were retrieved from practitionersprior to the educational interventions.Results: general practitioners' knowledge of dementia diagnosis and management is good, but poor awareness of its epidemiologyleads to an over-estimate of caseload. Knowledge of local diagnostic and support services is less good, and one third ofgeneral practitioners expressed limited confidence in their diagnostic skills, whilst two-thirds lacked confidence in managementof behaviour and other problems in dementia. The main difficulties identified by general practitioners were talking withpatients about the diagnosis, responding to behaviour problems and coordinating support services. General practitionersperceived lack of time and lack of social services support as the major obstacles to good quality care more often than theyidentified 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 practitionersbelieved that dementia care is within a specialist's domain, not that of general practice. More experienced and male generalpractitioners 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 werealso less likely to express attitudes endorsing open communication with patient and carer.Conclusion: educational support for general practitioners should concentrate on epidemiological knowledge, disclosure ofthe diagnosis and management of behaviour problems in dementia. The availability and profile of support services, particularlysocial 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

Journal
Age and Ageing: Volume 33, Issue 5