title: Role expectations in dementia care among family physicians and specialists.
abstract: BACKGROUND
  The assessment and ongoing management of dementia falls largely on family physicians. This pilot study explored perceived roles and attitudes towards the provision of dementia care from the perspectives of family physicians and specialists.
  
  
  METHODS
  Semi-structured, one-to-one interviews were conducted with six family physicians and six specialists (three geriatric psychiatrists, two geriatricians, and one neurologist) from University of Toronto-affiliated hospitals. Transcripts were subjected to thematic content analysis.
  
  
  RESULTS
  Physicians' clinical experience averaged 16 years. Both physician groups acknowledged that family physicians are more confident in diagnosing/treating uncomplicated dementia than a decade ago. They agreed on care management issues that warranted specialist involvement. Driving competency was contentious, and specialists willingly played the "bad cop" to resolve disputes and preserve long-standing therapeutic relationships. While patient/caregiver education and support were deemed essential, most physicians commented that community resources were fragmented and difficult to access. Improving collaboration and communication between physician groups, and clarifying the roles of other multi-disciplinary team members in dementia care were also discussed.
  
  
  CONCLUSIONS
  Future research could further explore physicians' and other multi-disciplinary members' perceived roles and responsibilities in dementia care, given that different health-care system-wide dementia care strategies and initiatives are being developed and implemented across Ontario.
authors.affiliation: Department of Family & Community Medicine, University of Toronto, Women's College Hospital, Toronto, ON;
authors.forename: Susan
authors.initials: S
authors.lastname: Hum
authors.affiliation: Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON;
authors.forename: Carole
authors.initials: C
authors.lastname: Cohen
authors.affiliation: Department of Health, Nursing & Environmental Studies, York University, Toronto, ON;
authors.forename: Malini
authors.initials: M
authors.lastname: Persaud
authors.affiliation: Department of Family & Community Medicine, University of Toronto, North York General Hospital, Toronto, ON;
authors.forename: Joyce
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Family Medicine, University of Alberta, Edmonton, AB;
authors.forename: Neil
authors.initials: N
authors.lastname: Drummond
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, ON.
authors.forename: William
authors.initials: W
authors.lastname: Dalziel
authors.affiliation: Department of Family & Community Medicine, University of Toronto, Women's College Hospital, Toronto, ON;
authors.forename: Nicholas
authors.initials: N
authors.lastname: Pimlott
keywords: attitudes; dementia; diagnosis; management; physicians