Primary care determinants for timely diagnosis of dementia
Hannah Gulline, Sarah Carmody, Amelia Bevins, Mark Yates, Stephanie Daly, Dimity Pond, Stephanie Perin, Amy Brodtmann, Samantha Loi, Yen Ying Lim, Heather Macklin, Kevyn Morris, Scott Ayton, Darshini AytonObjective
To identify actions of primary care physicians (PCPs) that influence referral to specialist assessment for dementia from the perspective of people with symptoms of dementia and/or their significant others.
Design
A descriptive qualitative design was used, involving 33 semistructured interviews that explored presenting symptoms, consultations with health professionals, tests undertaken and challenges encountered while navigating the prediagnostic phase of dementia. Interview data were mapped deductively to the Candidacy Framework to examine engagement with PCPs and to identify participant-perceived actions that facilitated or impeded timely diagnosis.
Setting
Online interviews were conducted between August 2022 and June 2023 with participants across Australia.
Participants
Participants were 37 people who had navigated the dementia diagnosis process as a patient or significant other (partner/spouse, adult child, sibling or friend).
Result
Successfully communicating concerns and asserting candidacy was described by participants as determining the diagnosis trajectory. Participants reflected that PCPs assessed available information to determine the need for specialist referral. Participants detailed that following PCP referral and support provision, diagnosis proceeded to a specialist. We also identified participant-reported system-level and PCP-related barriers to facilitating a timely diagnosis, including PCP time-constraints and workload-constraints, dementia-specific knowledge and referral pathway inconsistency. From participants’ perspectives, access to a specialist referral and timely diagnosis was facilitated or impeded by an interplay of actions by people experiencing symptoms, significant others, and PCPs.
Conclusions
Primary care barriers and enablers to timely diagnosis spanned across patient, significant other, PCP and system levels. Recommendations to provide timely, accurate and equitable dementia diagnoses include (1) Raise community awareness of dementia symptoms, helping people communicate their concerns effectively with their PCP; (2) Enhance PCP knowledge of dementia to improve their ability to refer and diagnose and (3) Develop clear diagnostic pathways to ensure that individuals receive the appropriate diagnosis and care they need.