The relationship between attitude, diagnosis and management of dementia in rural General Practice

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1 The relationship between attitude, diagnosis and management of dementia in rural General Practice Alzheimer s Australia 14 th National Conference May 2011 Angela Greenway Crombie PhD Candidate Supervisors: Dr Sam Davis, Prof Peter Disler, Dr Pam Snow, Prof Dimity Pond

2 Background Ageing of the population has led to a significant increase in the prevalence of dementia in Australia and indeed worldwide Over the past two decades, the number of elderly people increased by 165%, compared with a total population growth of 29% over the same period This growth is forecast to continue

3 Age structure Australia

4 Dementia prevalence ,600 new cases of dementia in Australia (1,338 new cases per week) ,200 new cases of dementia in Australia (7,407 new cases per week) Source: Access Economics, 2009

5 Background (cont.) 2009 people with dementia represent 1.1% of the total population in capital cities & 1.2% in the balance of the states 2050 increase to 2.9% in capital cities & 3.8% in the balance of the states Source: Access Economics, 2009

6 Background (cont.) GPs are the most likely professional for people with memory problems and their carers to contact with concerns Older people visit their GP 8 9 times a year on average (AIHW 2007) Evidence suggests that dementia is often not recognised by GPs Reported rates of overlooked dementia are between 35% and 90% (Valcour et al, 2000)

7 GP attitude & dementia GP attitude toward dementia impacts on patient care and management Positive attitudes are associated with active case finding, increased use of cognitive tests and early detection (Blair 1998)

8 GP Aged Care study Tri state multi centre randomised controlled trial intervention GPs receive training on detection & management of dementia Conducted by the Ageing in General Practice Team from the Universities of Newcastle, Adelaide, Melbourne, New South Wales and Monash Funded by NHMRC & rural arm by TIME for dementia

9 Rural arm main question Is there a difference in the detection and management of dementia by GPs in rural areas compared to urban areas?

10 Methodology GPs participating in the study were asked to complete a GP Attitudes and Confidence Survey supplementary audit form for people whom they had clinically considered to have definite, probable or possible dementia. The audit form asked GPs to indicate their management of the person s memory problems

11 Survey Results 3 urban sites and 1 rural site submitted the survey data included in this analysis 23 surveys were received from the urban sites and 13 from the rural site Responses were divided into 2 groups: 1 3 = doesn t apply; 4 6 = does apply The data was analysed and is presented as percentages to allow for the difference in the number of surveys from the rural and urban sites

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13 Rural/Urban attitude differences Of interest is the difference in responses to the statement Most patients are grateful when I address their cognitive decline. 77% of urban GPs indicated that this statement does apply compared to only 54% of rural GPs Differences were noted in response to the statement I would like to participate in training on how to deal and speak with dementing patients and their relatives with 85% of rural GPs responding that this statement does apply compared to only 55% of urban GPs. There was also a difference in response to the statement I suggest to relatives that they participate in a self help group with the majority of rural GPs (62%) answering in the affirmative and the majority of urban GPs (52%) answering in the negative.

14 Audit form results 1,553 patients were audited at baseline in the urban cohort with 195 (12.56%) identified as having definite, possible or probable dementia 138 patients were audited at baseline in the rural cohort with 27 (19.56%) identified as having definite, possible or probable dementia

15 Diagnosis of dementia 25% 20% 15% 10% Urban Rural 5% 0% No. w ith Definite dementia No. w ith Possible dementia No.w ith Probable dementia Total

16 Management of dementia 80% 70% 60% 50% 40% 30% Urban Rural 20% 10% 0% Memory problems discussed Pathology ordered Radiology Paper & pencil test MMSE specified Specialist referrals Referred to services

17 Rural/Urban management differences Urban GPs discussed memory problems with more of their patients than rural GPs Rural GPs ordered more pathology tests (mainly thyroid, B12 & U&E s) than their urban counterparts and conducted over 40% more paper & pencil tests & MMSE s than urban GPs Referrals for specialist testing and to support services were quite low in both the urban and rural cohorts

18 Summary Although the majority of GPs (Urban = 96%; Rural = 70%) responded that early detection of dementia benefits the patient it is a concern that 30% of rural GPs gave a negative response, particularly when the audit showed they are more likely to diagnose dementia GP response to the statement Guidelines for the diagnosis and treatment of dementia would help me with 77% of rural GPs and 73% of urban GPs answering in the affirmative is interesting as it may indicate that approximately 25% of GPs do not see Guidelines as a useful resource

19 Summary The most significant difference in response by urban & rural GPs was to the statement I would like to participate in training on how to deal and speak with dementing patients and their relatives 85% of rural GPs responded that this statement does apply compared to only 55% of urban GPs perhaps reduced access to education opportunities and/or the relationship between the GP, patient & their relatives in rural areas may have influenced this response

20 Summary Also of interest is the difference in responses to the statement Most patients are grateful when I address their cognitive decline Seventy seven percent of urban GPs indicated that this statement does apply compared to only 54% of rural GPs yet rural GPs were more likely to diagnose dementia and to order tests and refer to specialists thereby addressing cognitive decline

21 Conclusion Data on attitude, diagnosis and management of dementia in general practice has identified some differences between rural and urban practice settings About to commence qualitative interviews with rural GPs for a more comprehensive perspective focus on attitude to dementia, experience with disclosing diagnosis, previous education/training and what they perceive would most help implement best practice guidelines

22 Thank you