ArticleThe American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry2010
When help becomes a hindrance: mental health referral systems as barriers to care for primary care physicians treating patients with Alzheimer's disease.
Article in The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Physicians' Perspectives About Burnout: a Systematic Review and Metasynthesis.Journal of general internal medicine · 2019Pooled it
- Efficacy of a language-concordant community health worker intervention to improve community-to-clinic linkage for dementia care: results of the randomized trial PLAN.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026Trial
- Organisational factors associated with burnout among emergency and internal medicine physicians: a qualitative study.BMJ open · 2025Article
- Understanding Barriers Along the Patient Journey in Alzheimer's Disease Using Social Media Data.Neurology and therapy · 2023Article
- The use of formal care for dementia from a professional perspective: a scoping review.BMC health services research · 2022Article
- Dementia care and the role of guideline adherence in primary care: cross-sectional findings from the DemTab study.BMC geriatrics · 2021Article
- Diagnosis and management of dementia in primary care: exploratory study.Canadian family physician Medecin de famille canadien · 2014Article
- Curing and caring: the work of primary care physicians with dementia patients.Qualitative health research · 2011Article
- Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectivesTo describe structural barriers to mental health specialists and consequences of these barriers to care for patients with dementia and neuropsychological symptoms and their primary care physicians (PCPs).
designCross-sectional qualitative interview study of PCPs.
settingPhysicians' offices, primarily managed care.
participantsForty PCPs in Northern California. MEASUREMENTS: Open-ended interviews lasted 30-60 minutes. The interview guide covered clinician background, practice setting, clinical care of a particular patient, and general approach to managing patients with Alzheimer disease or related dementias.Interviews were transcribed and themes reflecting referrals identified.
resultsNinety-three percentage of the PCPs described problematic access to and communication with mental health specialists (in particular psychiatrists and neuropsychologists) as impediments to effective care for dementia patients. Thematic analysis identified structural barriers to mental health referrals ranging from problems with managed care and reimbursement policies to lack of trained providers and poor geographic distribution of specialists. Structural barriers compromised care for patients with dementia because the barriers limited PCP treatment options, and resources, impacted office staff and time with other patients, impeded and delayed care, and fostered poor communication and lack of coordinated care. Negative consequences for PCPs included increased frustration,conflict, and burnout.
conclusionPCPs viewed problems created by onerous referral systems, such as mental health carve outs, as particularly burdensome for elderly patients with comorbid dementia and neuropsychiatric problems. These problems were cited by PCPs across different types of practice settings. PCPs managed treatment of neurobehavioral symptoms as best they could despite lack of specialist support.
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