Outreach visits to improve dementia care in general practice: a qualitative study

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Abstract
Outreach visits reflect newer developments in adult learning theory, where the learner is actively involved in the session. Previous studies have indicated a postiive effect of outreach visits on GPs' behaviour. However, the empirical role of the facilitator in the visits is poorly described. To explore general practitioners' perception of the outcome of a facilitator programme about dementia, in relation to central aspects of the facilitator's communicative role during the visits. Observational studies, and focus group discussions with participating general practitioners (3 groups, 19 participants) as well as with facilitators (4 participants) in Vejle County, Denmark. Facilitators drew both on a ‘factual’ knowledge of dementia and a more ‘experience-based’ knowledge when conveying programme messages. They described themselves as ‘carriers of experience’. All general practitioners described an outcome of the programme, and all wished to receive a future visit by a facilitator on new topics. The outcome was described not as ground-breaking medical news, but as practical effects in terms of knowledge of dementia, motivation for working with dementia, structured assessment and management of dementia and critical reflection of established practices regarding dementia. Some general practitioners remained critical as to whether this outcome justified the resources used in the programme. The experience-based dialogue was described as central to the outcome as it linked factual knowledge to clinical practice. This study confirms that outreach visits contribute to the integration of factual knowledge in clinical practice, but it also underscores the importance of addressing tacit communicative practices during facilitator visits and their implications for the outcome of the programme.

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