Understanding diagnosis and management of dementia and guideline implementation in general practice: a qualitative study using the theoretical domains framework

Background Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important role in diagnosing and managing dementia; however, there are gaps between recommended and current practice. The aim of this study was to explo...

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Veröffentlicht in:	Implementation science : IS Jg. 9; H. 1; S. 31
Hauptverfasser:	Murphy, Kerry, O’Connor, Denise A, Browning, Colette J, French, Simon D, Michie, Susan, Francis, Jill J, Russell, Grant M, Workman, Barbara, Flicker, Leon, Eccles, Martin P, Green, Sally E
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	London BioMed Central 03.03.2014 BioMed Central Ltd Springer Nature B.V
Schlagworte:	Attitude of Health Personnel Dementia - diagnosis Dementia - epidemiology Dementia - therapy Depression - diagnosis Depression - epidemiology Female General Practitioners Guideline Adherence Health Administration Health aspects Health Informatics Health Knowledge, Attitudes, Practice Health Policy Health Promotion and Disease Prevention Health Services Research Humans Interviews as Topic Male Medical societies Medicine Medicine & Public Health Models, Theoretical Practice Practice Guidelines as Topic Public Health Qualitative Research Referral and Consultation Victoria - epidemiology Victoria Australia Depression assessment Guideline implementation General practitioners (GPs) Dementia Cognitive assessment Theoretical Domains Framework (TDF)
ISSN:	1748-5908, 1748-5908
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Abstract	Background Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important role in diagnosing and managing dementia; however, there are gaps between recommended and current practice. The aim of this study was to explore GPs’ reported practice in diagnosing and managing dementia and to describe, in theoretical terms, the proposed explanations for practice that was and was not consistent with evidence-based guidelines. Methods Semi-structured interviews were conducted with GPs in Victoria, Australia. The Theoretical Domains Framework (TDF) guided data collection and analysis. Interviews explored the factors hindering and enabling achievement of 13 recommended behaviours. Data were analysed using content and thematic analysis. This paper presents an in-depth description of the factors influencing two behaviours, assessing co-morbid depression using a validated tool, and conducting a formal cognitive assessment using a validated scale. Results A total of 30 GPs were interviewed. Most GPs reported that they did not assess for co-morbid depression using a validated tool as per recommended guidance. Barriers included the belief that depression can be adequately assessed using general clinical indicators and that validated tools provide little additional information (theoretical domain of ‘Beliefs about consequences’); discomfort in using validated tools (‘Emotion’), possibly due to limited training and confidence (‘Skills’; ‘Beliefs about capabilities’); limited awareness of the need for, and forgetting to conduct, a depression assessment (‘Knowledge’; ‘Memory, attention and decision processes’). Most reported practising in a manner consistent with the recommendation that a formal cognitive assessment using a validated scale be undertaken. Key factors enabling this were having an awareness of the need to conduct a cognitive assessment (‘Knowledge’); possessing the necessary skills and confidence (‘Skills’; ‘Beliefs about capabilities’); and having adequate time and resources (‘Environmental context and resources’). Conclusions This is the first study to our knowledge to use a theoretical approach to investigate the barriers and enablers to guideline-recommended diagnosis and management of dementia in general practice. It has identified key factors likely to explain GPs’ uptake of the guidelines. The results have informed the design of an intervention aimed at supporting practice change in line with dementia guidelines, which is currently being evaluated in a cluster randomised trial.
AbstractList	Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important role in diagnosing and managing dementia; however, there are gaps between recommended and current practice. The aim of this study was to explore GPs' reported practice in diagnosing and managing dementia and to describe, in theoretical terms, the proposed explanations for practice that was and was not consistent with evidence-based guidelines. Semi-structured interviews were conducted with GPs in Victoria, Australia. The Theoretical Domains Framework (TDF) guided data collection and analysis. Interviews explored the factors hindering and enabling achievement of 13 recommended behaviours. Data were analysed using content and thematic analysis. This paper presents an in-depth description of the factors influencing two behaviours, assessing co-morbid depression using a validated tool, and conducting a formal cognitive assessment using a validated scale. A total of 30 GPs were interviewed. Most GPs reported that they did not assess for co-morbid depression using a validated tool as per recommended guidance. Barriers included the belief that depression can be adequately assessed using general clinical indicators and that validated tools provide little additional information (theoretical domain of 'Beliefs about consequences'); discomfort in using validated tools ('Emotion'), possibly due to limited training and confidence ('Skills'; 'Beliefs about capabilities'); limited awareness of the need for, and forgetting to conduct, a depression assessment ('Knowledge'; 'Memory, attention and decision processes'). Most reported practising in a manner consistent with the recommendation that a formal cognitive assessment using a validated scale be undertaken. Key factors enabling this were having an awareness of the need to conduct a cognitive assessment ('Knowledge'); possessing the necessary skills and confidence ('Skills'; 'Beliefs about capabilities'); and having adequate time and resources ('Environmental context and resources'). This is the first study to our knowledge to use a theoretical approach to investigate the barriers and enablers to guideline-recommended diagnosis and management of dementia in general practice. It has identified key factors likely to explain GPs' uptake of the guidelines. The results have informed the design of an intervention aimed at supporting practice change in line with dementia guidelines, which is currently being evaluated in a cluster randomised trial. Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important role in diagnosing and managing dementia; however, there are gaps between recommended and current practice. The aim of this study was to explore GPs' reported practice in diagnosing and managing dementia and to describe, in theoretical terms, the proposed explanations for practice that was and was not consistent with evidence-based guidelines.BACKGROUNDDementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important role in diagnosing and managing dementia; however, there are gaps between recommended and current practice. The aim of this study was to explore GPs' reported practice in diagnosing and managing dementia and to describe, in theoretical terms, the proposed explanations for practice that was and was not consistent with evidence-based guidelines.Semi-structured interviews were conducted with GPs in Victoria, Australia. The Theoretical Domains Framework (TDF) guided data collection and analysis. Interviews explored the factors hindering and enabling achievement of 13 recommended behaviours. Data were analysed using content and thematic analysis. This paper presents an in-depth description of the factors influencing two behaviours, assessing co-morbid depression using a validated tool, and conducting a formal cognitive assessment using a validated scale.METHODSSemi-structured interviews were conducted with GPs in Victoria, Australia. The Theoretical Domains Framework (TDF) guided data collection and analysis. Interviews explored the factors hindering and enabling achievement of 13 recommended behaviours. Data were analysed using content and thematic analysis. This paper presents an in-depth description of the factors influencing two behaviours, assessing co-morbid depression using a validated tool, and conducting a formal cognitive assessment using a validated scale.A total of 30 GPs were interviewed. Most GPs reported that they did not assess for co-morbid depression using a validated tool as per recommended guidance. Barriers included the belief that depression can be adequately assessed using general clinical indicators and that validated tools provide little additional information (theoretical domain of 'Beliefs about consequences'); discomfort in using validated tools ('Emotion'), possibly due to limited training and confidence ('Skills'; 'Beliefs about capabilities'); limited awareness of the need for, and forgetting to conduct, a depression assessment ('Knowledge'; 'Memory, attention and decision processes'). Most reported practising in a manner consistent with the recommendation that a formal cognitive assessment using a validated scale be undertaken. Key factors enabling this were having an awareness of the need to conduct a cognitive assessment ('Knowledge'); possessing the necessary skills and confidence ('Skills'; 'Beliefs about capabilities'); and having adequate time and resources ('Environmental context and resources').RESULTSA total of 30 GPs were interviewed. Most GPs reported that they did not assess for co-morbid depression using a validated tool as per recommended guidance. Barriers included the belief that depression can be adequately assessed using general clinical indicators and that validated tools provide little additional information (theoretical domain of 'Beliefs about consequences'); discomfort in using validated tools ('Emotion'), possibly due to limited training and confidence ('Skills'; 'Beliefs about capabilities'); limited awareness of the need for, and forgetting to conduct, a depression assessment ('Knowledge'; 'Memory, attention and decision processes'). Most reported practising in a manner consistent with the recommendation that a formal cognitive assessment using a validated scale be undertaken. Key factors enabling this were having an awareness of the need to conduct a cognitive assessment ('Knowledge'); possessing the necessary skills and confidence ('Skills'; 'Beliefs about capabilities'); and having adequate time and resources ('Environmental context and resources').This is the first study to our knowledge to use a theoretical approach to investigate the barriers and enablers to guideline-recommended diagnosis and management of dementia in general practice. It has identified key factors likely to explain GPs' uptake of the guidelines. The results have informed the design of an intervention aimed at supporting practice change in line with dementia guidelines, which is currently being evaluated in a cluster randomised trial.CONCLUSIONSThis is the first study to our knowledge to use a theoretical approach to investigate the barriers and enablers to guideline-recommended diagnosis and management of dementia in general practice. It has identified key factors likely to explain GPs' uptake of the guidelines. The results have informed the design of an intervention aimed at supporting practice change in line with dementia guidelines, which is currently being evaluated in a cluster randomised trial. Background Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important role in diagnosing and managing dementia; however, there are gaps between recommended and current practice. The aim of this study was to explore GPs' reported practice in diagnosing and managing dementia and to describe, in theoretical terms, the proposed explanations for practice that was and was not consistent with evidence-based guidelines. Methods Semi-structured interviews were conducted with GPs in Victoria, Australia. The Theoretical Domains Framework (TDF) guided data collection and analysis. Interviews explored the factors hindering and enabling achievement of 13 recommended behaviours. Data were analysed using content and thematic analysis. This paper presents an in-depth description of the factors influencing two behaviours, assessing co-morbid depression using a validated tool, and conducting a formal cognitive assessment using a validated scale. Results A total of 30 GPs were interviewed. Most GPs reported that they did not assess for co-morbid depression using a validated tool as per recommended guidance. Barriers included the belief that depression can be adequately assessed using general clinical indicators and that validated tools provide little additional information (theoretical domain of 'Beliefs about consequences'); discomfort in using validated tools ('Emotion'), possibly due to limited training and confidence ('Skills'; 'Beliefs about capabilities'); limited awareness of the need for, and forgetting to conduct, a depression assessment ('Knowledge'; 'Memory, attention and decision processes'). Most reported practising in a manner consistent with the recommendation that a formal cognitive assessment using a validated scale be undertaken. Key factors enabling this were having an awareness of the need to conduct a cognitive assessment ('Knowledge'); possessing the necessary skills and confidence ('Skills'; 'Beliefs about capabilities'); and having adequate time and resources ('Environmental context and resources'). Conclusions This is the first study to our knowledge to use a theoretical approach to investigate the barriers and enablers to guideline-recommended diagnosis and management of dementia in general practice. It has identified key factors likely to explain GPs' uptake of the guidelines. The results have informed the design of an intervention aimed at supporting practice change in line with dementia guidelines, which is currently being evaluated in a cluster randomised trial. Keywords: Dementia, General practitioners (GPs), Cognitive assessment, Depression assessment, Theoretical Domains Framework (TDF), Guideline implementation Doc number: 31 Abstract Background: Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important role in diagnosing and managing dementia; however, there are gaps between recommended and current practice. The aim of this study was to explore GPs' reported practice in diagnosing and managing dementia and to describe, in theoretical terms, the proposed explanations for practice that was and was not consistent with evidence-based guidelines. Methods: Semi-structured interviews were conducted with GPs in Victoria, Australia. The Theoretical Domains Framework (TDF) guided data collection and analysis. Interviews explored the factors hindering and enabling achievement of 13 recommended behaviours. Data were analysed using content and thematic analysis. This paper presents an in-depth description of the factors influencing two behaviours, assessing co-morbid depression using a validated tool, and conducting a formal cognitive assessment using a validated scale. Results: A total of 30 GPs were interviewed. Most GPs reported that they did not assess for co-morbid depression using a validated tool as per recommended guidance. Barriers included the belief that depression can be adequately assessed using general clinical indicators and that validated tools provide little additional information (theoretical domain of 'Beliefs about consequences'); discomfort in using validated tools ('Emotion'), possibly due to limited training and confidence ('Skills'; 'Beliefs about capabilities'); limited awareness of the need for, and forgetting to conduct, a depression assessment ('Knowledge'; 'Memory, attention and decision processes'). Most reported practising in a manner consistent with the recommendation that a formal cognitive assessment using a validated scale be undertaken. Key factors enabling this were having an awareness of the need to conduct a cognitive assessment ('Knowledge'); possessing the necessary skills and confidence ('Skills'; 'Beliefs about capabilities'); and having adequate time and resources ('Environmental context and resources'). Conclusions: This is the first study to our knowledge to use a theoretical approach to investigate the barriers and enablers to guideline-recommended diagnosis and management of dementia in general practice. It has identified key factors likely to explain GPs' uptake of the guidelines. The results have informed the design of an intervention aimed at supporting practice change in line with dementia guidelines, which is currently being evaluated in a cluster randomised trial. Background Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important role in diagnosing and managing dementia; however, there are gaps between recommended and current practice. The aim of this study was to explore GPs’ reported practice in diagnosing and managing dementia and to describe, in theoretical terms, the proposed explanations for practice that was and was not consistent with evidence-based guidelines. Methods Semi-structured interviews were conducted with GPs in Victoria, Australia. The Theoretical Domains Framework (TDF) guided data collection and analysis. Interviews explored the factors hindering and enabling achievement of 13 recommended behaviours. Data were analysed using content and thematic analysis. This paper presents an in-depth description of the factors influencing two behaviours, assessing co-morbid depression using a validated tool, and conducting a formal cognitive assessment using a validated scale. Results A total of 30 GPs were interviewed. Most GPs reported that they did not assess for co-morbid depression using a validated tool as per recommended guidance. Barriers included the belief that depression can be adequately assessed using general clinical indicators and that validated tools provide little additional information (theoretical domain of ‘Beliefs about consequences’); discomfort in using validated tools (‘Emotion’), possibly due to limited training and confidence (‘Skills’; ‘Beliefs about capabilities’); limited awareness of the need for, and forgetting to conduct, a depression assessment (‘Knowledge’; ‘Memory, attention and decision processes’). Most reported practising in a manner consistent with the recommendation that a formal cognitive assessment using a validated scale be undertaken. Key factors enabling this were having an awareness of the need to conduct a cognitive assessment (‘Knowledge’); possessing the necessary skills and confidence (‘Skills’; ‘Beliefs about capabilities’); and having adequate time and resources (‘Environmental context and resources’). Conclusions This is the first study to our knowledge to use a theoretical approach to investigate the barriers and enablers to guideline-recommended diagnosis and management of dementia in general practice. It has identified key factors likely to explain GPs’ uptake of the guidelines. The results have informed the design of an intervention aimed at supporting practice change in line with dementia guidelines, which is currently being evaluated in a cluster randomised trial. Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important role in diagnosing and managing dementia; however, there are gaps between recommended and current practice. The aim of this study was to explore GPs' reported practice in diagnosing and managing dementia and to describe, in theoretical terms, the proposed explanations for practice that was and was not consistent with evidence-based guidelines. Semi-structured interviews were conducted with GPs in Victoria, Australia. The Theoretical Domains Framework (TDF) guided data collection and analysis. Interviews explored the factors hindering and enabling achievement of 13 recommended behaviours. Data were analysed using content and thematic analysis. This paper presents an in-depth description of the factors influencing two behaviours, assessing co-morbid depression using a validated tool, and conducting a formal cognitive assessment using a validated scale. A total of 30 GPs were interviewed. Most GPs reported that they did not assess for co-morbid depression using a validated tool as per recommended guidance. Barriers included the belief that depression can be adequately assessed using general clinical indicators and that validated tools provide little additional information (theoretical domain of 'Beliefs about consequences'); discomfort in using validated tools ('Emotion'), possibly due to limited training and confidence ('Skills'; 'Beliefs about capabilities'); limited awareness of the need for, and forgetting to conduct, a depression assessment ('Knowledge'; 'Memory, attention and decision processes'). Most reported practising in a manner consistent with the recommendation that a formal cognitive assessment using a validated scale be undertaken. Key factors enabling this were having an awareness of the need to conduct a cognitive assessment ('Knowledge'); possessing the necessary skills and confidence ('Skills'; 'Beliefs about capabilities'); and having adequate time and resources ('Environmental context and resources'). This is the first study to our knowledge to use a theoretical approach to investigate the barriers and enablers to guideline-recommended diagnosis and management of dementia in general practice. It has identified key factors likely to explain GPs' uptake of the guidelines. The results have informed the design of an intervention aimed at supporting practice change in line with dementia guidelines, which is currently being evaluated in a cluster randomised trial.
ArticleNumber	31
Audience	Academic
Author	Browning, Colette J Workman, Barbara Russell, Grant M French, Simon D O’Connor, Denise A Francis, Jill J Michie, Susan Flicker, Leon Green, Sally E Eccles, Martin P Murphy, Kerry
AuthorAffiliation	9 Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK 7 Department of Medicine, Monash Medical Centre and Monash University, Monash VIC 3800, Australia 4 Department of Psychology, University College London, London, UK 3 Centre for Health, Exercise and Sports Medicine, Melbourne School of Health Sciences, University of Melbourne, 200 Berkeley St, Carlton, VIC 3010, Australia 2 School of Primary Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, VIC 3168, Australia 5 School of Health Sciences, City University London, London, UK 6 Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, VIC 3168, Australia 8 Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia 1 School of Public Health and Preventive Medicine, Monash University,
AuthorAffiliation_xml	– name: 4 Department of Psychology, University College London, London, UK – name: 1 School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia – name: 7 Department of Medicine, Monash Medical Centre and Monash University, Monash VIC 3800, Australia – name: 9 Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK – name: 3 Centre for Health, Exercise and Sports Medicine, Melbourne School of Health Sciences, University of Melbourne, 200 Berkeley St, Carlton, VIC 3010, Australia – name: 2 School of Primary Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, VIC 3168, Australia – name: 8 Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia – name: 6 Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, VIC 3168, Australia – name: 5 School of Health Sciences, City University London, London, UK
Author_xml	– sequence: 1 givenname: Kerry surname: Murphy fullname: Murphy, Kerry organization: School of Public Health and Preventive Medicine, Monash University – sequence: 2 givenname: Denise A surname: O’Connor fullname: O’Connor, Denise A email: denise.oconnor@monash.edu organization: School of Public Health and Preventive Medicine, Monash University – sequence: 3 givenname: Colette J surname: Browning fullname: Browning, Colette J organization: School of Primary Health Care, Monash University – sequence: 4 givenname: Simon D surname: French fullname: French, Simon D organization: Centre for Health, Exercise and Sports Medicine, Melbourne School of Health Sciences, University of Melbourne – sequence: 5 givenname: Susan surname: Michie fullname: Michie, Susan organization: Department of Psychology, University College London – sequence: 6 givenname: Jill J surname: Francis fullname: Francis, Jill J organization: School of Health Sciences, City University London – sequence: 7 givenname: Grant M surname: Russell fullname: Russell, Grant M organization: Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University – sequence: 8 givenname: Barbara surname: Workman fullname: Workman, Barbara organization: Department of Medicine, Monash Medical Centre and Monash University – sequence: 9 givenname: Leon surname: Flicker fullname: Flicker, Leon organization: Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia – sequence: 10 givenname: Martin P surname: Eccles fullname: Eccles, Martin P organization: Institute of Health and Society, Newcastle University – sequence: 11 givenname: Sally E surname: Green fullname: Green, Sally E organization: School of Public Health and Preventive Medicine, Monash University
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/24581339$$D View this record in MEDLINE/PubMed
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ContentType	Journal Article
Copyright	Murphy et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. COPYRIGHT 2014 BioMed Central Ltd. 2014 Murphy et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. Copyright © 2014 Murphy et al.; licensee BioMed Central Ltd. 2014 Murphy et al.; licensee BioMed Central Ltd.
Copyright_xml	– notice: Murphy et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. – notice: COPYRIGHT 2014 BioMed Central Ltd. – notice: 2014 Murphy et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. – notice: Copyright © 2014 Murphy et al.; licensee BioMed Central Ltd. 2014 Murphy et al.; licensee BioMed Central Ltd.
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DOI	10.1186/1748-5908-9-31
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Keywords	Depression assessment Guideline implementation General practitioners (GPs) Dementia Cognitive assessment Theoretical Domains Framework (TDF)
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Snippet	Background Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important... Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important role in... Background Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important... Doc number: 31 Abstract Background: Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners...
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SubjectTerms	Attitude of Health Personnel Dementia - diagnosis Dementia - epidemiology Dementia - therapy Depression - diagnosis Depression - epidemiology Female General Practitioners Guideline Adherence Health Administration Health aspects Health Informatics Health Knowledge, Attitudes, Practice Health Policy Health Promotion and Disease Prevention Health Services Research Humans Interviews as Topic Male Medical societies Medicine Medicine & Public Health Models, Theoretical Practice Practice Guidelines as Topic Public Health Qualitative Research Referral and Consultation Victoria - epidemiology
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Title	Understanding diagnosis and management of dementia and guideline implementation in general practice: a qualitative study using the theoretical domains framework
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