The identification of barriers to the recognition of, and response to, dementia in primary care using a modified focus group approach

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Abstract
This study reports upon the identification of barriers to the recognition of and response to dementia in primary care as perceived by general practitioners and highlights areas of information and training need. The study took a qualitative approach involving group work with 144 general practitioners in three purposively selected settings using adapted nominal group data collection methods. Six key themes were identified that explain the complexity of dementia diagnosis and management: (1) the pre-eminence of problem-solving over differential diagnosis as a working style; (2) the existence of gaps in support services; (3) problems of confidentiality; (4) the importance of ‘red flags’; (5) rules governing disclosure of diagnoses; and (6) heuristics for distinguishing dementia from normal ageing or other pathologies. In addition the practitioners identified principles governing medication use, issues around carers’ needs and implications for professional education. The National Service Framework for Older People emphasizes the need for early detection and diagnosis of dementia in primary care. This study identified barriers to be overcome by targeted educational interventions and through service provision. There is an uneven geographical distribution of support and diagnostic services and a lack of awareness of how to access these, and this needs addressing. A stepwise educational method is recommended as opposed to promotion of a formal syllabus.

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