By Dr Margaret Winbolt, Director, Dementia Training Australia, La Trobe University and AJDC Advisory Board member
The diagnosis of dementia has long been seen as the province of medical specialists such as geriatricians, neurologists and psychiatrists. However, the increasing number of people presenting with symptoms now places diagnosis firmly within the domain of the primary health sector in general and with GPs in particular. GPs are now being asked to identify and diagnose dementia, referring only unusual or complex presentations to specialists. Once the diagnosis is made, GPs are in the position of having to provide the necessary ongoing care and support to both the person with dementia and their family carers.
Whilst GPs have a generally positive attitude to the importance of recognition and early diagnosis they may be reluctant to make a diagnosis, citing such things as a sense of there being no point as there is no meaningful treatments available, a fear of stigmatising the person, the risk of damaging their relationship with the person and, a lack of referral options post diagnosis (Giezendanner et al 2019; Mason et al 2020).
Underlying many negative perceptions and apparent barriers is GPs’ level of knowledge about, and attitudes to, dementia together with a low level of confidence in making a diagnosis (Mason et al 2020; Harmand et al 2018).
Overcoming these barriers requires GPs to have the necessary knowledge and skills not only to make the diagnosis but to provide ongoing care. GPs report having received minimal dementia content in both their undergraduate course or GP training programs and GP trainee supervisors have been shown to have little more knowledge than the trainees they supervise (Tierney et al 2019).
The recognition of this and the known role of education in increasing GPs’ knowledge and confidence (Pond et al 2018) has guided the work of Dementia Training Australia’s (DTA’s) GP education group. The group is led by a committed team of GPs, all of whom have a keen interest in improving the care of people living with dementia and increasing the ability of GPs to provide this care. This has resulted in the development of a series of workshops and online courses specifically for GPs (see http://bit.ly/DTA-online-courses and http://bit.ly/dta-gpcelearning).
Delivered by GPs, these DTA courses and workshops offer GPs and GP trainees practical approaches to diagnosis and care and explore how a GP might best approach communicating the diagnosis to the patient. The training has been shown to increase participants’ knowledge and confidence in relation to dementia (Mason et al 2020; Tierney et al 2019).
Other initiatives aimed at assisting GPs in the process of diagnosis and post-diagnosis support include the international COGNISANCE project, described in the April-May 2020 issue of AJDC (https://journalofdementiacare.data.com.au/Home/Index). COGNISANCE will provide information to guide GPs and other health practitioners in implementing dementia guidelines in five countries. The project will also develop a package of information specifically for people concerned they may have dementia.
Initiatives such as these will improve and support the ability of GPs to identify and diagnose dementia as well as their ability to provide ongoing care.
Giezendanner et al (2019) General Practitioners’ Attitudes Towards Early Diagnosis Of Dementia: A Cross-Sectional Survey. BMC Family Practice 20(65). Available at: https://doi.org/10.1186/s12875-019-0956-1.
Harmand MG, Meillon C, Rullier L, Taddé OB, Pimouguet C, Dartigues JF, Bergua V, Amieva H (2018) Description Of General Practitioners’ Practices When Suspecting Cognitive Impairment. Recourse To Care In Dementia (Recaredem) Study. Aging & Mental Health 22(8) 1046-1055.
Mason R, Doherty K, Eccleston C, Winbolt M, Long M, Robinson A (2020) Effect Of A Dementia Education Intervention On The Confidence And Attitudes Of General Practitioners In Australia: A Pretest Post-Test Study. BMJ Open 10(1). Available at: https://bmjopen.bmj.com/content/10/1/e033218.full.
Pond D, Mate K, Stocks N, Gunn J, Disler P, Magin P, Marley J, Paterson N, Horton G, Goode S, Weaver N, Brodaty H (2018) Effectiveness Of A Peer-Mediated Educational Intervention In Improving General Practitioner Diagnostic Assessment And Management Of Dementia: A Cluster Randomised Controlled Trial. BMJ Open 8(8). Available at: https://www.ncbi.nlm.nih.gov/pubmed/30121596.
Tierney L, Mason R, Doherty K, Winbolt M, Long M, Robinson A (2019) Workshops On Diagnosis And Management Of Dementia For General Practitioners: A Pre-Post Intervention Study Of Dementia Knowledge. BMJ Open 9(4). Available at: https://www.ncbi.nlm.nih.gov/pubmed/30967411.