title: Management of behavioural change in patients presenting with a diagnosis of dementia: a video vignette study with Australian general practitioners.
abstract: OBJECTIVE
  To test the impact of feedback on the proposed management of standardised patients presenting with behavioural change with a diagnosis of dementia in Australian primary care.
  
  
  METHODS
  A video vignette study was performed with Australian general practitioners (GPs) in 2013. Participants viewed six pairs of matched videos depicting people presenting changed behaviour in the context of a dementia diagnosis in two phases. In both phases GPs indicated their diagnosis and management. After phase 1, GPs were offered feedback on management strategies for the patients depicted. Analyses focused on identification of change in management between the two phases of the study. Factors impacting on the intention to coordinate care for such patients were tested in a questionnaire based on the Theory of Planned Behaviour.
  
  
  RESULTS
  Forty-five GPs completed the study. There was significant improvement in the proposed management of three of the six scenarios after the intervention. Older GPs were more likely to refer appropriately (OR=1.11 (1.01 to 1.23), p=0.04.). Overall referral to support agencies was more likely after the intervention (OR=2.52 (1.53 to 4.14), p<0.001). Older GPs were less likely to intend to coordinate care for such patients (OR=0.89 (0.81 to 0.98) p=0.02). Participants who felt confident about their ability to coordinate care were more likely to do so (OR=3.79 (1.08 to 13.32) p=0.04).
  
  
  CONCLUSIONS
  The intervention described in this study promoted multidisciplinary management of patients with behavioural problems with a diagnosis of dementia. Increasing practitioner confidence in their ability to coordinate care may increase the proportion of GPs who will respond to patients and carers in this context. Older GPs may benefit in particular.
authors.affiliation: Department of Medical Education, Curtin University, Perth, Australia.
authors.forename: Moyez
authors.initials: M
authors.lastname: Jiwa
authors.affiliation: Dementia Behaviour Management Advisory Services, Alzheimer's Australia WA Ltd, Subiaco, Australia.
authors.forename: Pam
authors.initials: P
authors.lastname: Nichols
authors.affiliation: Discipline of General Practice, University of Newcastle, Callaghan, North South Wales, Australia.
authors.forename: Parker
authors.initials: P
authors.lastname: Magin
authors.affiliation: Department of Medical Education, Curtin University, Perth, Australia.
authors.forename: Georgina
authors.initials: G
authors.lastname: Pagey
authors.affiliation: Faculty of Health Science, School of Public Health, Curtin University, Perth, Australia.
authors.forename: Xingqiong
authors.initials: X
authors.lastname: Meng
authors.affiliation: School of Occupational Therapy & Social Work and School of Pharmacy, Curtin University, Perth, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Parsons
authors.affiliation: Department of Medical Education, Curtin University, Perth, Australia.
authors.forename: Vinita
authors.initials: V
authors.lastname: Pillai
mesh_terms: D000328:Adult; D003153:Community Health Services; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D014741:Video Recording
keywords: PRIMARY CARE