How does Australian primary care face dementia? Identifying current practice and barriers in dementia diagnosis and management in Australian primary care - a qualitative interview study.

backgroundPrimary care is increasingly tasked with early detection, diagnosis, and management of dementia. Despite policy initiatives, education investments, and development of diagnostic and care pathways in Australia and globally, dementia care in primary care settings remains sub-optimal. This study is part of a bigger project titled Facing Dementia Together, comprising a primary care practice change program and a public help-seeking campaign, aimed at improving timely detection and management of dementia in primary care. A core element of intervention research is understanding the context in which the intervention is to be developed, implemented and evaluated. The aim of this study is to identify current practice and barriers to dementia identification, diagnosis and management in primary care in two regions in Australia.

methodsA qualitative design with semi-structured interviews was used. The interview guide was informed by projective techniques using hypothetical scenarios. A convenience sample of 18 key primary care stakeholders were recruited through the Western Victoria and Western Sydney Primary Health Networks located in two different states of Australia. DATA ANALYSIS: Data was thematically analysed following Braun and Clarke’s six steps of thematic analysis The socioecological model was used to guide the development of themes.

resultsFour themes described current primary care practitioner practices in dementia diagnosis and management (1) Family concern triggers dementia investigation (2) GPs delay conversations about dementia (3) Completing routine cognitive assessments in the 75+ health assessment, and (4) Variability in post-diagnostic care. Barriers to identifying, diagnosing, and managing dementia were organised according to the levels of the socioecological framework: ‘There is not much we can do’ (individual), ‘A difficult conversation’ (Interpersonal), ‘Hierarchy affects team communication’ (Organisational), ‘It’s hard to get services’ (Community) and ‘If it’s not financially viable, it won’t be done’ (Policy).

conclusionEnhancing care for people living with dementia and their carers requires multifaceted interventions that not only strengthen the capability and motivation of primary care practitioners, but also address intrapersonal, community, organisational, and policy-related challenges. The findings of this study inform the Facing Dementia Together primary care practice change intervention to improve early dementia diagnosis and management in primary care.