Putting dementia awareness into general practice : The CADIF approach.
BACKGROUND
International studies show that dementia is often recognized at later stages in general practice. Pure knowledge-sharing interventions could not change this in a sustainable manner. Concepts for changing attitudes of general practitioners (GPs) are required.


OBJECTIVE
What barriers affect GPs' recognition of and diagnostic approach to dementia? What recommendations for a GP-specific diagnostic procedure can be derived from this?


METHODS
Metasynthesis of qualitative studies with GPs on barriers to dementia recognition, explication of the "frailty" concept and the diagnostic approach described therein and the development of an approach in cases of suspected cognitive decline in a multiprofessional team.


RESULTS
A metasynthesis of qualitative studies revealed a lack of a general practice framework in the diagnostic approach of GPs, characterized by poor patient-centeredness and confusion of early detection, diagnostics and disclosure. The embedding of cognitive decline into the geriatric triad is intended to promote the focus on everyday function and quality of life, i.e. on caring instead of curing. The proposed concept for a transfer into practice emphasizes increased awareness for cognitive warning signs among practice personnel, a geriatric and personal approach to the patient, as well as follow-up assessment and monitoring.


CONCLUSIONS
In contrast to early recognition, awareness initially does not imply an active search for cognitive deficits with questions and tests but a vigilance for red flags. The described scheme is a component of a complex intervention for attitude change among GPs towards dementia.
Institute of General Practice (ifam) and Centre for Health and Society (chs), Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany. pentzek@med.uni-duesseldorf.de.
Michael
M
Pentzek
Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.|Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.
Horst Christian
HC
Vollmar
Institute of General Practice (ifam) and Centre for Health and Society (chs), Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
Stefan
S
Wilm
Institute of General Practice (ifam) and Centre for Health and Society (chs), Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
Verena
V
Leve
D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D003943:Diagnostic Techniques, Neurological / Q000706:statistics & numerical data; D042241:Early Diagnosis; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D058005:General Practitioners / Q000523:psychology / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology
Attitudes of health personnel; Cognition; Dementia; Diagnosis; Health services research