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General practitioners (GPs) play a pivotal role in dementia recognition, yet research suggests that dementia often remains undetected in primary care. Lack of knowledge might be a major contributing factor to low recognition rates. Our objective was to address a gap in the scientific literature by exploring GPs’ knowledge on dementia and mild cogni...
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Background:
The implementation of evidence-based interventions for people with dementia is complex and challenging. However, successful implementation might be a key element to ensure evidence-based practice and high quality of care. There is a need to improve implementation processes in dementia care by better understanding the arising challenges...
Citations
... Perhaps this was also due to a Hungarian phenomenon where, according to a 2019 study, GPs deemed the most common form of this disease in Hungary to be the vascular type of dementia. This could be the primary reason why an officially recommended screening protocol is only available for this type of dementia on the Hungarian General Practice Partnership's website; however, this could also be the result of the distorted collective opinion of GPs [27]. ...
Background: Dementia is a significant health issue worldwide. Mild cognitive impairment (MCI) can transform into dementia over time. General practitioners (GPs) may be the first to notice the cognitive deficit; therefore, it is crucial for them to have access to a screening test that can be administered quickly and efficiently. We explored the Hungarian version of the Test Your Memory self-administered dementia screening test in general practice for the early detection of dementia and cognitive impairment. Methods: In the four Hungarian cities with medical universities, 368 patients over the age of 50 attending GPs filled out the questionnaire within the framework of our cross-sectional study. Results: The total scores of the test showed a significant correlation with education and type of occupation and a significant negative correlation with age. The results of this research showed that the clock drawing and recall subtest scores deteriorate at the earliest age. Conclusion: The test can be filled out in a GP’s office easily and two of its subtests can raise the possibility that patients may need further assessment, especially if they have symptoms, at an earlier age than the other subtests.
... Addressing diagnostic hesitancy in Primary Care Physicians (PCP) is of particular importance, since 1) they usually have a gatekeeping role within the healthcare system for patients (3,4); and 2) the trusting nature of the relationship between the patient and PCP makes them better equipped to understand concerns and pick up on subtle changes in patient's cognitive function (5). Unfortunately, physicians delay diagnosis (6,7), between 6 months to 2 years (8). Only about 50% of all ADRD cases are diagnosed, and this typically occurs later in the cognitive spectrum (9). ...
Objective: Migration of physicians in Puerto Rico makes it difficult to obtain specialized care for Alzheimer's disease and related dementias (ADRD). Primary care physicians (PCPs) can fill this gap, but there is limited information on how their beliefs and behaviors towards ADRD affect early diagnostic practices. Using the Theory of Planned Behavior (TPB), we addressed salient beliefs of PCPs that affect their intention to diagnose ADRD early, defined as "performing the recommended clinical testing to diagnose ADRD within 3 months from the patient's first subjective memory complaint". Methods: This cross-sectional study included 103 Puerto Rican PCPs, surveyed at CME activities and online. We measured PCPs salient beliefs in terms of attitudes, pressure they feel from others, self-perception of ability to diagnose ADRD early, and intention to perform early diagnosis. Questionnaire measures were psychometrically acceptable. Results: Structural equation modeling (PLS-SEM) analysis showed that, combined, framework constructs explained 35.7% of the variance, reflecting a moderate-to-strong intention of PCPs to diagnose early (R 2 = 0.357, p < 0.001). Self-perception of skills was the strongest predictor of intention (ß= 0.378, p < 0.001). Hours in ADRD training and years of experience in medical practice were strongly correlated with the percentage of total diagnoses performed by PCPs. Conclusion: Training and years of experience may be key for PCPs to have a positive outlook of their skills for early ADRD diagnosis. Findings could be useful to design interventions to dispel myths about ADRD, reduce stigma, and reduce diagnostic hesitancy toward ADRD among PCPs. [P R Health Sci J 2023;42(3):212-218]
... Most studies have focused on PCP's knowledge, attitudes, and confidence towards dementia diagnosis. [17][18][19][20][21] However, limited studies explored PCPs' cognitive evaluation practice. Understanding the current practice and its influencing factors is critical to enhance detection and improve primary healthcare system. ...
Introduction:
Dementia is a global challenge for healthcare systems, including Malaysia. Despite evidence-based Clinical Practice Guidelines (CPG) for dementia management in primary care, detection is poor. Improving detection rates requires understanding current practice and influencing factors. This study aims to assess the practice of cognitive evaluation among primary care practitioners (PCPs) and its associated factors, as well as its correlation with their knowledge and attitudes towards early dementia diagnosis.
Materials and methods:
A cross-sectional study conducted online, using Google FormTM recruited 207 Medical Officers from 14 public primary health centres, with a response rate of 74%. The Knowledge, Attitude and Practice Questionnaire for Family Physicians (KAPQFP) was used to assess PCPs' knowledge, attitude and practice in dementia care. Items in each domain were scored on a 4-point Likert scale, with scores ranging from 1 to 4. Each domain's mean score was divided by 4 and converted to a scale of 100, with higher scores indicating better knowledge, attitude and practice. Bivariate analyses were conducted to determine the factors associated with cognitive evaluation practice.
Results:
The overall mean practice score was 3.53±0.52 (88.3%), which is substantially higher than the mean score for perceived competency and knowledge of 2.46±0.51 (61.5%). The mean score for attitude towards dementia and collaboration with nurses and other healthcare professionals was 3.36±0.49 (84.0%) and 3.43±0.71 (85.8%), respectively. PCPs with prior dementia training showed better practice (p=0.006), as did PCPs with longer primary care work experience (p=0.038). A significant positive association was found between knowledge-practice ((rs=0.207, p=0.003), attitude towards dementia practice ((rs=0.478, p<0.001), and attitude towards collaboration with other healthcare professionals-practice (rs= 0.427, p<0.001). Limited time and inadequate knowledge regarding dementia diagnosis and cognitive evaluation tools were among the reasons cognitive evaluations were not performed.
Conclusion:
PCPs demonstrated better practice of cognitive evaluation, as compared to their knowledge and attitude. Given that their perceived competency and knowledge on dementia diagnosis is low and is positively associated with their practice, it is crucial to implement a comprehensive dementia training to enhance their knowledge and confidence on early detection of cognitive decline and cognitive evaluation in order to achieve better dementia detection in primary care.
... A cohort study in the US over a two-year period found that training support was effective in improving the confidence of primary care workers in dementia care and their competency in using the cognitive screening tools [30]. Continuing education was also found to be beneficial for improving MCI detection in primary care in a study in Hungary [31]. We did not test the moderation effect of training on the association between MCI knowledge and attitudes because of the lack of significant association (p = 0.938) between MCI training and attitude scores. ...
... A questionnaire was developed through a thorough examination of the existing tools in relation to the testing constructs [31,42,43]. This was followed by focus groups interviews with 32 MCI patients and their caregivers, 42 GPs, and 18 CHC managers to adapt the tools to the specific context of China. ...
Background:
General practitioners (GPs) play a critical role in community detection and management of mild cognitive impairment (MCI). Although adequate knowledge is essential, healthcare practice is shaped by intrinsic and extrinsic factors. This study aimed to test the mediating effect of perceived extrinsic barriers on the associations between knowledge, attitudes, and intended practice of GPs in community detection and management of MCI.
Methods:
A cross-sectional study was conducted through an online survey of 1253 GPs sampled from 56 community health centres (CHCs) in Shanghai in 2021. Perceived extrinsic barriers were rated on a five-point Likert scale for patient engagement, working environment, and system context, respectively. A summed score was generated subsequently for each domain ranging from 0 to 100, with a higher score indicating higher barriers. The mediating effect of perceived extrinsic barriers (second-order) and the moderation effect of training on the association between MCI knowledge and practice scores, as well as the moderation effect of past experience on the association between MCI knowledge and extrinsic barriers, were tested through structural equation modelling (SEM) with a partial least square (PLS) approach.
Results:
The study participants reported an average barrier score of 65.23 (SD = 13.98), 58.34 (SD = 16.95), and 60.37 (SD = 16.99) for patient engagement, working environment, and system context, respectively. Although knowledge had both direct and indirect (through attitudes) effects on intended practice, perceived extrinsic barriers negatively mediated (β = - 0.012, p = 0.025) the association between knowledge and practice. Training moderated the effect of knowledge on practice (β = - 0.066, p = 0.014).
Conclusions:
Perceived extrinsic barriers have a detrimental effect on the translation of knowledge into practice for community detection and management of MCI. The effect of training on practice declines when knowledge scores become higher.
... CHCs in Shanghai. The questionnaire was developed through a thorough examination of the existing tools measuring MCI-associated KAP in medical practitioners [30,46], and adapted to the specific context of China through focus group interviews with 32 MCI patients and 32 caregivers, 42 GPs, and 18 CHC managers in Shanghai. This was followed by two rounds of Delphi consultations with 24 experts with specialisations in general practice, cognitive psychology, dementia care, or health system and services management. ...
... In addition, the KAP measurement scales were highly aligned with the existing tools despite adaptation to the Chinese context. For example, the knowledge items covered those included in the "Knowledge of general practitioners on dementia and mild cognitive impairment" [46] and the "dementia knowledge assessment tool" [50]. The attitudes items covered those included in the General Practitioner Attitudes and Confidence Scale [51]. ...
... The alerting domain contained two questions asking respondents whether they would be alerted to start MCI screening by memory loss and psychiatric symptoms of patients, respectively, for suspected MCI cases. In primary care, these symptoms are dominant patient complaints that lead to the diagnosis of MCI and dementia [46]. Answers to each question included 3 "yes", 2 "unsure" or 1 "no". ...
Background
General practitioners (GPs) are in a unique position for community detection and management of mild cognitive impairment (MCI). However, adequate knowledge, attitudes, and practice (KAP) are prerequisites for fulfilling such a role. This study aims to assess the MCI-related KAP of GPs in Shanghai, China.
Methods
An online survey was conducted on 1253 GPs who were recruited from 56 community health centres (CHCs) in Shanghai between April and May 2021. Knowledge (8 items), attitudes (13 items), and practice (11 items) were assessed using a scale endorsed by a panel of multidisciplinary experts. An average summed score was calculated and transformed into a score ranging from 0 to 100 for knowledge, attitudes, and practice, respectively. Adjusted odds ratios (AORs) were calculated for potential predictors of higher levels of KAP scores (with mean value as a cutoff point) through logistic modelling. The mediating role of attitudes on the association between knowledge and practice was tested using the PROCESS model 4 macro with 5000 bootstrap samples through linear regression modelling.
Results
A total of 1253 GPs completed the questionnaire, with an average score of 54.51 ± 18.18, 57.31 ± 7.43, and 50.05 ± 19.80 for knowledge, attitudes, and practice, respectively. More than 12% of respondents scored zero in knowledge, 28.4% tended not to consider MCI as a disease, and 19.1% completely rejected MCI screening. Higher levels of knowledge were associated with more favourable attitudes toward community management of MCI (AOR = 1.974, p < 0.001). Higher compliance with practice guidelines was associated with both higher levels of knowledge (AOR = 1.426, p < 0.01) and more favourable attitudes (AOR = 2.095, p < 0.001). The association between knowledge and practice was partially mediated by attitudes ( p < 0.001). Training was associated with higher levels of knowledge (AOR = 1.553, p < 0.01), while past experience in MCI management was associated with more favourable attitudes (AOR = 1.582, p < 0.05) and higher compliance with practice guidelines (AOR = 3.034, p < 0.001). MCI screening qualification was associated with higher compliance with practice guidelines (AOR = 2.162, p < 0.05), but less favourable attitudes (AOR = 0.452, p < 0.05).
Conclusion
The MCI knowledge of GPs in Shanghai is low, and is associated with less favourable attitudes toward MCI management and low compliance with practice guidelines. Attitudes mediate the association between knowledge and practice. Training is a significant predictor of knowledge. Further studies are needed to better understand how the attitudes of GPs in Shanghai are shaped by the environments in which they live and work.
... This is in line with a previous study conducted in Hungary in 2019 among 209 GPs demonstrating that GPs listed vascular and metabolic risk factors most often as being risk factors for dementia. 31 In contrast, a study conducted in Spain reported on the unawareness among GPs and pharmacists with regard to hypercholesterolemia and hypertension as being risk factors for dementia. 32 Differences in the knowledge of healthcare professionals between countries might be due to several factors/circumstances such as the national policy on dementia and the availability and the level of educational/training programs for healthcare professionals focused on dementia (risk reduction). ...
Background:
The total number of people affected by dementia worldwide is increasing rapidly. Recent studies provided evidence for the contribution of modifiable risk and protective factors to dementia risk. Although healthcare professionals could play an essential role in informing the general public about the relationship between lifestyle and dementia, it is unclear what they know about this relationship. Therefore, this study assesses the awareness of dementia risk reduction among current and future healthcare professionals.
Design and methods:
An online survey was carried out among 182 healthcare students from Maastricht University and 20 general practitioners (GPs) and practice nurses in Limburg, The Netherlands. The survey assessed the knowledge about risk and protective factors of dementia and identified needs, wishes and barriers concerning dementia risk reduction strategies.
Results:
The majority of current (75.0%) and future (81.9%) healthcare professionals indicated that dementia risk reduction is possible. Among students, awareness of cardiovascular risk factors of dementia (e.g., coronary heart disease (44.5%), hypertension (53.8%)) was low. Most participants (>70.0%) would like to receive more information about dementia risk reduction.
Conclusions:
The majority of current and future healthcare professionals were aware of the relationship between lifestyle and dementia risk. However, there are still substantial gaps in knowledge regarding individual dementia risk factors. Given the essential role of healthcare professionals in providing lifestyle advice, there is a need to increase awareness by providing educational programs focused on dementia risk reduction.
... A questionnaire was developed through a thorough examination of the existing tools in relation to the testing constructs (39,42,43). This was followed by focus groups interviews with 32 MCI patients and their caregivers, 42 GPs, and 18 CHC managers in order to adapt the tools to the speci c context of China. ...
Background
General practitioners (GPs) play a critical role in community detection and management of mild cognitive impairment (MCI). Although adequate knowledge is essential, healthcare practice is shaped by many factors, both intrinsic and extrinsic. This study aimed to test the mediating effect of perceived extrinsic barriers on the associations between knowledge, attitudes and intended practice of GPs in community detection and management of MCI.
Methods
A cross-sectional study was conducted through an online survey of 1253 GPs sampled from 56 community health centres (CHCs) in Shanghai in 2021. Perceived extrinsic barriers were rated on a five-point Likert scale for patient engagement, working environment, and system context, respectively. A summed score was generated subsequently for each domain ranging from 0 to 100, with a higher score indicating higher barriers. The mediating effect of perceived extrinsic barriers (second-order) and the moderation effects of training and past experience on the association between MCI knowledge and practice scores were tested through structural equation modelling (SEM) with a partial least square (PLS) approach.
Results
The study participants reported an average barrier score of 65.23 (SD=13.98), 58.34 (SD=16.95) and 60.37 (SD=16.99) for patient engagement, working environment, and system context, respectively. Although knowledge had both direct and indirect (through attitudes) effects on intended practice, perceived extrinsic barriers negatively mediated (β=-0.012, p=0.025) the association between knowledge and practice. Training moderated the effect of knowledge on practice (β=-0.066, p=0.014).
Conclusions
Perceived extrinsic barriers have a detrimental effect on the translation of knowledge into practice for community detection and management of MCI. The effect of training on practice declines when knowledge scores become higher.
... In light of these results, some clinical implications may be highlighted. Increasing the knowledge related to the identification of dementia symptoms and the management of these, through psycho-educational sessions or educational programs, for both family caregivers (e.g., Chien & Tann, 2019) and gerontology professionals (Imre et al. 2019) seems to be beneficial and recommended. It has been suggested that a greater satisfaction with information about a relative's illness is associated with lower distress in critical patient family carers (Gómez-Carretero et al., 2009). ...
... It has been suggested that a greater satisfaction with information about a relative's illness is associated with lower distress in critical patient family carers (Gómez-Carretero et al., 2009). Gerontology professionals working with dementia patients should try to transmit their knowledge about the illness (which has recently been suggested to be adequate, Imre et al. 2019) in a better and more efficient way to caregivers. Further, such educational sessions should be integrated in clinical interventions which may change caregivers' maladaptive ways of thinking and coping, as the effect of this knowledge on caregiver health seems to be mediated by higher levels of dysfunctio-nal thoughts and experiential avoidance. ...
Dysfunctional ways of thinking and coping with caregiving have been associated with worse caregivers’ cardiovascular health. The objective of this study is to analyze the associations between caregivers’ knowledge about Alzheimer’s disease, dysfunctional thoughts, experiential avoidance, and blood pressure. Participants were 123 family caregivers of a relative with dementia. Path analysis was used to analyze the association between the assessed variables. The obtained model shows that there is a significant and negative relationship between caregivers’ knowledge about Alzheimer’s disease and systolic blood pressure, potentially mediated by caregivers’ dysfunctional thoughts and experiential avoidance. The findings of this study provide support to the idea that a lack of knowledge about Alzheimer’s disease may contribute to maladaptive ways of thinking about caregiving, increasing caregivers’ cardiovascular risk.
... To meet the aims of the project, a self-administered questionnaire was designed specifically to explore a broad range of aspects regarding GPs' role in dementia detection and management in Hungary. The project investigated several significant topics, including GPs' routines and perspectives regarding dementia detection in Hungary (which is covered by the present paper); GPs' factual knowledge of dementia [10] and also their attitudes regarding dementia patients and their management [11]. The development and validation of the questionnaire was a multistage process, taking up one year ( Figure 1). ...
Background: Undetected dementia in primary care is a global problem. Since general practitioners (GPs) act as the first step in the identification process, examining their routines could help us to enhance the currently low recognition rates.
Objectives: The study aimed to explore, for the first time in Hungary, the dementia identification practices and views of GPs.
Methods: In the context of an extensive, national survey (February-November 2014) 8% of all practicing GPs in Hungary (n = 402) filled in a self-administered questionnaire. The questions (single, multiple-choice, Likert-type) analysed in the present study explored GPs’ methods and views regarding dementia identification and their ideas about the optimal circumstances of case-finding.
Results: The vast majority of responding GPs (97%) agreed that the early recognition of dementia would enhance both the patients’ and their relatives’ well-being. When examining the possibility of dementia, most GPs (91%) relied on asking the patients general questions and only a quarter of them (24%) used formal tests, even though they were mostly satisfied with both the Clock Drawing Test (69%) and the Mini-Mental State Examination (65%). Longer consultation time was chosen as the most important facet of improvement needed for better identification of dementia in primary care (81%). Half of the GPs (49%) estimated dementia recognition rate to be lower than 30% in their practice.
Conclusions: Hungarian GPs were aware of the benefits of early recognition, but the shortage of consultation time in primary care was found to be a major constraint on efficient case-finding.
Introduction:
Detection of mild cognitive impairment (MCI) is essential in slowing progression to dementia. Primary care plays a vital role in detecting and managing MCI. The chronic care model (CCM) provides effective methods to manage chronic diseases.
Objective:
This study aimed to explore how MCI services are delivered in primary care in China.
Methods:
Focus group interviews were conducted face to face among MCI stakeholders from six community health centres (CHCs) involved in the 'friendly community programme' in Shanghai, China. A total of 124 MCI stakeholders were interviewed, consisting of 6 groups (n=42) of general practitioners (GPs), 3 groups (n=18) of CHC managers, 4 groups (n=32) of people with MCI and 4 groups (n=32) of informal caregivers. Content and thematic analyses were performed using a combination of induction and deduction approaches.
Results:
Three major themes emerged from the data corresponding to the CCM framework: hesitant patients, unprepared providers and misaligned environments. While the public are hesitant to seek medical attention for MCI problems, due to misunderstanding, social stigma and a lack of perceived benefits, GPs and CHCs are not well prepared either, due to lack of knowledge and a shortage of GPs, and a lack of policy, funding and information support. None of these issues can be addressed separately without tackling the others.
Conclusion:
This study combined the diverse perceptions of all the main stakeholders to detect and manage MCI in primary care settings in China. A vicious circle was found among the three interconnected CCM domains, creating a gridlock that should be addressed through a system's approach targeting all of the above-mentioned aspects.
