Improving the management of dementia in general practice
In its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) reports on a new trial focused on improving management of patients with dementia in general practice.
Early diagnosis of dementia offers a window of control in a disintegrating world
Christina Hagger writes:
Dementia carries many burdens. There is the lost productivity for people living with dementia, as well as their carers; the need for costly support services and the emotional costs suffered both by people with the disease as well as the impact on their families and friends.
GPs are often reluctant to diagnose a disease that causes such immense suffering and also lacks a known cure.
Yet, there are some positive outcomes to be gained from an early diagnosis. It allows people to plan ahead and, importantly, even retain some sense of control.
Early recognition of symptoms can allow reversible causes of cognitive decline to be addressed as well as identification and management of co-morbidities such as depression.
Early diagnosis also allows patients time to plan their futures (e.g. prepare wills, appoint enduring powers of attorney) while they are still competent to do so. Anti-dementia medication that may slow the course of cognitive decline may be trialled. People can be referred to support services such as memory clinics.
Significantly, timely education for patients and families may help them understand and cope with the challenge of this disease and thus assist people to live at home longer.
There are a range of reasons why GPs fail to identify dementia early in the course of the disease and also adhere poorly to published dementia guidelines. These include limited consultation times, and lack of relevant knowledge and attitudinal factors.
Australian researchers have begun a cluster randomised trial to examine the effectiveness of a peer led interactive educational intervention as well as training in the use of a dementia screening instrument to improve accurate and timely diagnosis of dementia by GPs.
The primary outcomes are carer and consumer quality of life while secondary outcomes include the rates of GP identification of dementia.
This trial is underway (more details here). Currently 2,034 subjects have been recruited and the intervention delivered to 114 GPs.
Many will be watching for the results with interest.
• Christina Hagger, Research Fellow, Primary Health Care Research & Information Service (PHC RIS)
Ageing in General Practice (AGP) Trial: A cluster randomised trial to examine the effectiveness of peer education on GP diagnostic assessment and management of dementia. BMC Family Practice 2012, 13:12
Pond CD, Brodaty H, Stocks NP, Gunn J, Marley J, Disler P, Magin PJ, Paterson N, Horton G, Goode SM, Paine B & Mate KE.
This article, which can be accessed at http://www.biomedcentral.com/1471-2296/13/12/abstract, features in the 15 March 2012 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php. The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field. Those interested in receiving the weekly eBulletin are invited to subscribe to the free service at http://www.phcris.org.au/mailinglists/index.php
Previous PHC RIS columns at Croakey
• Pets and what they do for our health