Diagnosis and management of dementia in family practice

Abstract

Background: Improving quality of care for people with dementia is a high priority. Considerable resources have been invested in financial incentives, guideline development, public awareness and educational programmes to promote earlier diagnosis and better management.

Objectives: Evaluating family physicians’ concordance with guidelines on diagnosis and management of people with dementia, from first documentation of symptoms to formal diagnosis.

Method: Analysis of medical records of 136 people with dementia recruited by 19 family practices in NW London and surrounding counties.

Results: Practices invited 763 people with dementia to participate, 167 (22%) agreed. Complete records were available for 136 (18%). The majority of records included reference to recommended blood tests, informant history and caregiver concerns. Presence or absence of symptoms of depression, psychosis, other behavioural and psychological symptoms of dementia, and cognitive function tests were documented in 30%–40% of records. Documentation of discussions about signs and symptoms of dementia, treatment options, care, support, financial, legal and advocacy advice were uncommon. Comparison of these findings from a similar study in 2000–2002 suggests improvements in concordance with blood tests, recording informant history, presence or absence of depression or psychosis symptoms. There was no difference in documenting cognitive function tests. Immediate referral to specialists was more common in the recent study.

Conclusion: Five years after UK dementia guidelines and immediately after the launch of the dementia strategy, family physicians appeared concordant with clinical guidelines for dementia diagnosis (other than cognitive function tests), and referred most patients immediately. However, records did not suggest systematic dementia management.

Keywords:

• dementia
• memory disorders
• general practice
• primary care
• family medicine
• diagnosis
• management
• medical records
• concordance

Acknowledgements

The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the DOH.Additional funding was received in the form of Service Support Costs to recompense practices for their involvement. Additional NHS funding was given to extend the contract of one of the researchers and allow completion of data collection.We would like to express our gratitude and appreciation to the doctors, nurses and practice staff who have supported the study.

Disclosure statement

The authors declare that they have no competing interests.

Additional information

Funding

This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0606-1005).