Objective:
To investigate general practitioners' (gps) attitudes and practices in relation to screening, diagnosing, and disclosing a dementia diagnosis to patients.
Design:
National postal survey.
Participants:
A random sample of 600 gps from a national database of 2,400.
Results:
Of the 600 gps surveyed, 60% returned questionnaires of which 50% (300) were useable. gps reported diagnosing on average four new cases of dementia annually. a multivariate analysis revealed that females diagnosed significantly fewer cases annually (t=5.532, df=289, p<0.001). a large majority of gps reported performing thyroid function tests (77%), b(12) (75%) and folic acid tests (75%) to out rule reversible causes of cognitive impairment. the most reliable signs and symptoms of dementia identified were memory problems (58%). main barriers to diagnosis were difficulty differentiating normal ageing from symptoms of dementia (31%), lack of confidence (30%) and the impact of the diagnosis on the patient (28%). gps' age (chi(2)=14.592, df=3, p<0.005) and gender (chi(2)=11.436, df=3, p<0.01) were significantly associated with barriers to diagnosis. only 19% claimed they often or always disclosed a diagnosis to a patient. over one-third of gps (38%) reported that the key factor influencing their disclosure patterns was their perceptions of the patient's level of comprehension. most gps (90%) had never undergone any dementia specific training and most (83%) expressed a desire for this.
Conclusions:
Gps experience difficulty diagnosing and disclosing a diagnosis of dementia to patients. to improve dementia care in ireland, there is an urgent need to develop an active and more systematic approach to gp training in dementia care.