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BMC Primary Care
Published in: BMC Primary Care 1/2021

Open Access 01-12-2021 | Care | Research

Effects of the dementia care toolbox on personnel’s self-reported confidence in patient care: a CRT in general practices

Authors: Sabine Christine Jäger, Anna-Liesa Filbert, Thomas Welchowski, Birgitta Weltermann

Published in: BMC Primary Care | Issue 1/2021

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Abstract

Background

In rapidly aging populations, general practitioners (GPs) are challenged in dementia care of patients with and without migration background. Uncertainties in treating dementia in migrant patients due to language barriers or information deficits are reported. To address these deficits, we developed the Dementia Care Toolbox which was judged helpful by GP practice personnel. This two-armed cluster-randomised trial (CRT) investigated the effects of this toolbox on German GPs’ and practice assistants’ (PrAs) attitudes and confidence in dementia care, especially in patients with migration background.

Methods

A total of 32 GP practices were recruited and randomised into intervention (toolbox use for 3 months) and waiting-list control (toolbox after follow-up). After 3 months all participating GPs and PrAs received a standardised questionnaire addressing their levels of self-reported confidence in dementia care for patients with and without migration background. A generalized estimating equation model that took practice cluster effects into account was applied to assess GPs and PrAs self-reported confidence in dementia care in patients with and without migration background.

Results

Overall, the intervention had no significant effect on self-reported confidence in dementia care. However, the use of the dementia care toolbox showed a tendency for a learning effect on knowledge about local support structures for migrant patients with dementia (odds ratio 1.43; 95% CI 0.68-3.03, p = 0.35) and for less communication difficulties with dementia patients in general (odds ratio 0.72; 95% CI 0.33-1.56; p = 0.40). Moreover, intervention practices showed a tendency towards more awareness of own limitations: less self-confidence regarding answering questions (odds ratio 0.82; 95% CI 0.36-1.86, p = 0.64) and providing information for patients with migration background (odds ratio 0.60; 95% CI 0.25-1.45, p = 0.26).

Conclusion

The Toolbox Dementia Care increased awareness on the respective topic. Given a small sample size, further studies on its effectiveness in primary care are needed.

Trial registration

German Clinical Trials Register, DRKS00014632. Registered 02/08/2018.
Literature
1.
2.
3.
4.
Wimo A, Jönsson L, Bond J, Prince M, Winblad B. Alzheimer disease international. The worldwide economic impact of dementia 2010. Alzheimers Dement. 2013;9(1):1–11.CrossRef
5.
Michalowsky B, Kaczynski A, Hoffmann W. The economic and social burden of dementia diseases in Germany- a meta-analysis. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2019;62(8):981–92.CrossRef
6.
7.
Banerjee S, Willis R, Matthews D, Contell F, Chan J, Murray J. Improving the quality of care for mild to moderate dementia: an evaluation of the Croydon memory service model. Int J Geriatr Psychiatry. 2007;22(8):782–8.CrossRef
8.
Carpenter BD, Xiong C, Porensky EK, Lee MM, Brown P, Coats M, et al. Reaction to a dementia diagnosis in individuals with Alzheimer's disease and mild cognitive impairment. J Am Geriatr Soc. 2008;56(3):405–12.CrossRef
9.
Dubois B, Padovani A, Scheltens P, Rossi A, Dell'Agnello G. Timely diagnosis for Alzheimer's disease: a literature review on benefits and challenges. J Alzheimers Dis. 2016;49(3):617–31.CrossRef
10.
Solomon P, Murphy CA. Should we screen for Alzheimer's disease?: a review of the evidence for and against screening Alzheimer's disease in primary care practice. Geriatrics. 2005;60(11):26–31.PubMed
11.
Cahill S, Clark M, Walsh C, O'Connell H, Lawlor B. Dementia in primary care: the first survey of Irish general practitioners. Int J Geriatr Psychiatry. 2006;21(4):319–24.CrossRef
12.
Iliffe S, Manthorpe J, Eden A. Sooner or later? Issues in the early diagnosis of dementia in general practice: a qualitative study. Fam Pract. 2003;20(4):376–81.CrossRef
13.
Iliffe S, Robinson L, Brayne C, Goodman C, Rait G, Manthorpe J, et al. Primary care and dementia: 1. Diagnosis, screening and disclosure. Int J Geriatr Psychiatry. 2009;24(9):895–901.CrossRef
14.
Turner S, Iliffe S, Downs M, Wilcock J, Bryans M, Levin E, et al. General practitioners' knowledge, confidence and attitudes in the diagnosis and management of dementia. Age Ageing. 2004;33(5):461–7.CrossRef
15.
Pathak KP, Montgomery A. General practitioners’ knowledge, practices, and obstacles in the diagnosis and management of dementia. Aging Ment Health. 2015;19(10):912–20.CrossRef
16.
Foley T, Boyle S, Jennings A, Smithson WH. “We’re certainly not in our comfort zone”: a qualitative study of GPs’ dementia-care educational needs. BMC Fam Pract. 2017;18(1):66.CrossRef
17.
Ahmad S, Orrell M, Iliffe S, Gracie A. GPs' attitudes, awareness, and practice regarding early diagnosis of dementia. Br J Gen Pract. 2010;60(578):e360–5.CrossRef
18.
Bradford A, Kunik ME, Schulz P, Williams SP, Singh H. Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer Dis Assoc Disord. 2009;23(4):306–14.CrossRef
19.
Fox M, Fox C, Cruickshank W, Penhale B, Poland F, Steel N. Understanding the dementia diagnosis gap in Norfolk and Suffolk: a survey of general practitioners. Qual Prim Care. 2014;22(2):101–7.PubMed
20.
Nielsen TR, Vogel A, Riepe MW, Mendonca A, Rodriguez G, Nobili F, et al. Assessment of dementia in ethnic minority patients in Europe: a European Alzheimer’s disease consortium survey. Int Psychogeriatr. 2011;23(1):86–95.CrossRef
21.
22.
Segers K, Benoit F, Colson C, Kovac V, Nury D, Vanderaspoilden V. Pioneers in migration, pioneering in dementia: first generation immigrants in a European metropolitan memory clinic. Acta Neurol Belg. 2013;113(4):435–40.CrossRef
23.
Diaz E, Kumar BN, Enedal K. Immigrant patients with dementia and memory impairment in primary health Care in Norway: a National Registry Study. Dement Geriatr Cogn Disord. 2015;39(5-6):321–31.CrossRef
24.
Tillmann J, Just J, Schnakenberg R, Weckbecker K, Weltermann B, Münster E. Challenges in diagnosing dementia in patients with a migrant background - a cross-sectional study among German general practitioners. BMC Fam Pract. 2019;20(1):34.CrossRef
25.
26.
Filbert AL, Jäger SC, Weltermann B. Acceptance and self-reported use of a dementia care toolbox by general practice personal: results from an intervention study in German practices. BMC Fam Pract. 2020;21(1):264.CrossRef
27.
Tillmann J, Schnakenberg R, Puth MT, Weckbecker K, Just J, Münster E. Barriers in general practitioners' dementia diagnostics among people with a migration background in Germany (BaDeMi)- study protocol for a cross-sectional survey. BMC Med Res Methodol. 2018;18(1):124.CrossRef
28.
29.
30.
Casey AN, Islam MM, Schütze H, Parkinson A, Yen L, Shell A, et al. GP awareness, practice, knowledge and confidence: evaluation of the first nation-wide dementia-focused continuing medical education program in Australia. BMC Fam Pract. 2020;21(1):104.CrossRef
31.
Lathren CR, Sloane PD, Hoyle JD, Zimmermann S, Kaufer DI. Improving dementia diagnosis and management in primary care: a cohort study of the impact of a training and support program on physician competency, practice patterns, and community linkages. BMC Geriatr. 2013;13:134.CrossRef
32.
Foley T, Jennings A, Boyle S, Smithson WH. The development and evaluation of peer-facilitated dementia workshops in general practice. Educ Prim Care. 2017;29(1):27–34.CrossRef
33.
Mason RL, Annear MJ, Lo A, McInerney F, Tierney LT, Robinson AL. Development and preliminary psychometric properties of the general practitioner attitudes and confidence scale (GPACS-D) for dementia. BMC Fam Pract. 2016;17:105.CrossRef
34.
Sagbakken M, Spilker RS, Nielsen TR. Dementia and immigrant groups: a qualitative study of challenges related to identifying, assessing, and diagnosing dementia. BMC Health Serv Res. 2018;18(1):910.CrossRef
35.
Giezendanner S, Monsch AU, Kressig RW, Mueller Y, Streit S, Essig S, et al. Early diagnosis and management of dementia in general practice- how do Swiss GPs meet the challenge? Swiss Med Wkly. 2018;148:w14695.PubMed
36.
Czapka EA, Sagbakken M. "it is always me against the Norwegian system." barriers and facilitators in accessing and using dementia care by minority ethic groups in Norway: a qualitative study. BMC Health Serv Res. 2020;20(1):954.CrossRef
37.
Mukadam N, Cooper C, Livingston GA. A systematic review of ethnicity and pathways to care in dementia. Int J Geriatr Psychiatry. 2011;26(1):12–20.CrossRef
Metadata
Title
Effects of the dementia care toolbox on personnel’s self-reported confidence in patient care: a CRT in general practices
Authors
Sabine Christine Jäger
Anna-Liesa Filbert
Thomas Welchowski
Birgitta Weltermann
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2021
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-021-01577-8

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