Dementia in primary care: the first survey of Irish general practitioners

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 2400. 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 (X-2 = 14.592, df = 3, p < 0.005) and gender (X-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. Copyright (c) 2006 John Wiley & Sons, Ltd.