Perspectives on dementia care amongst primary care providers

Background Persons with dementia require extensive medical and psychosocial support to delay progression and prolong functional independence. Early diagnosis improves quality of life, symptom management, and caregiver burden. Primary care providers (PCPs) are commonly the initial healthcare point of contact for individuals with dementia. However, there is a tendency towards under‐diagnosing dementia in the primary care setting and a majority of patients receive no formal diagnosis nor dementia type differentiation. Individuals with dementia also experience low rates of specialist referrals. Our aim is to describe the perspectives of PCPs regarding the management of dementia in order to identify areas for improving early dementia care delivery. Method We conducted a survey of 208 Internal Medicine PCPs practicing across three institutions in Denver, Colorado, including an academic hospital, Veterans Affairs system, and a local county hospital. A five‐point Likert scale was used to assess held views on clinical training, challenges of care compared to non‐neurologic illness (heart failure and diabetes), the PCP’s role in dementia care, screening and diagnosis, resources for referral, and barriers to care coordination. Results A total of 26 providers responded at a rate of 12.5%. Additional training in: triggers for referral, care plan formulation, and behavioral symptom management were identified as helpful to these providers. A number of responders strongly agreed that dementia care was challenging (37.5%, r 2 =0.44, SD=0.66) compared to managing heart failure or diabetes (r 2 =0.83, SD=0.91). PCPs reported a lack of referral resources (45.8%), difficulties in care coordination (41.7%) and minimally agreed with the statement that there “are effective ways to manage dementia” (79.1%). The biggest barriers to dementia care delivery were “inadequate time” (r 2 =1.17, SD=1.08) and “inadequate resources for ongoing care” (r 2 =0.80, SD=0.89). Conclusion PCP viewpoints on the challenges of dementia care, but perceived lack of effective management strategies, suggest a disconnect between clinical practice and evidence showing the benefits of comprehensive dementia care. Access to specialists (e.g. neurologists, geriatricians) might improve dementia care by improving allocation of dementia support resources. Our response rate is consistent with published, disincentivized surveys of PCPs.