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Unburdening dementia: : a basic social process grounded theory based on a primary care physician survey from 25 countries

Petrazzuoli, Ferdinando LU orcid ; Vinker, Shlomo ; Palmqvist, Sebastian LU orcid ; Midlöv, Patrik LU orcid ; Lepeleire, Jan De ; Pirani, Alessandro ; Frese, Thomas ; Buono, Nicola ; Ahrensberg, Jette and Asenova, Radost , et al. (2020) In Scandinavian Journal of Primary Health Care 38(3). p.253-264
Abstract

OBJECTIVE: To explore dementia management from a primary care physician perspective.

DESIGN: One-page seven-item multiple choice questionnaire; free text space for every item; final narrative question of a dementia case story. Inductive explorative grounded theory analysis. Derived results in cluster analyses. Appropriateness of dementia drugs assessed by tertiary care specialist.

SETTING: Twenty-five European General Practice Research Network member countries.

SUBJECTS: Four hundred and forty-five key informant primary care physician respondents of which 106 presented 155 case stories.

MAIN OUTCOME MEASURES: Processes and typologies of dementia management. Proportion of case stories with drug treatment and... (More)

OBJECTIVE: To explore dementia management from a primary care physician perspective.

DESIGN: One-page seven-item multiple choice questionnaire; free text space for every item; final narrative question of a dementia case story. Inductive explorative grounded theory analysis. Derived results in cluster analyses. Appropriateness of dementia drugs assessed by tertiary care specialist.

SETTING: Twenty-five European General Practice Research Network member countries.

SUBJECTS: Four hundred and forty-five key informant primary care physician respondents of which 106 presented 155 case stories.

MAIN OUTCOME MEASURES: Processes and typologies of dementia management. Proportion of case stories with drug treatment and treatment according to guidelines.

RESULTS: Unburdening dementia - a basic social process - explained physicians' dementia management according to a grounded theory analysis using both qualitative and quantitative data. Unburdening starts with Recognizing the dementia burden by Burden Identification and Burden Assessment followed by Burden Relief. Drugs to relieve the dementia burden were reported for 130 of 155 patients; acetylcholinesterase inhibitors or memantine treatment in 89 of 155 patients - 60% appropriate according to guidelines and 40% outside of guidelines. More Central and Northern primary care physicians were allowed to prescribe, and more were engaged in dementia management than Eastern and Mediterranean physicians according to cluster analyses. Physicians typically identified and assessed the dementia burden and then tried to relieve it, commonly by drug prescriptions, but also by community health and home help services, mentioned in more than half of the case stories.

CONCLUSIONS: Primary care physician dementia management was explained by an Unburdening process with the goal to relieve the dementia burden, mainly by drugs often prescribed outside of guideline indications. Implications: Unique data about dementia management by European primary care physicians to inform appropriate stakeholders. Key points Dementia as a syndrome of cognitive and functional decline and behavioural and psychological symptoms causes a tremendous burden on patients, their families, and society. •We found that a basic social process of Unburdening dementia explained dementia management according to case stories and survey comments from primary care physicians in 25 countries. •First, Burden Recognition by Identification and Assessment and then Burden Relief - often by drugs. •Prescribing physicians repeatedly broadened guideline indications for dementia drugs. The more physicians were allowed to prescribe dementia drugs, the more they were responsible for the dementia work-up. Our study provides unique data about dementia management in European primary care for the benefit of national and international stakeholders.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian Journal of Primary Health Care
volume
38
issue
3
pages
12 pages
publisher
Taylor & Francis
external identifiers
  • pmid:32720874
  • scopus:85088866166
ISSN
0281-3432
DOI
10.1080/02813432.2020.1794166
language
English
LU publication?
yes
id
e2726827-cef7-45ff-9e3f-bd601cb13a1b
date added to LUP
2020-08-02 12:40:44
date last changed
2024-06-26 19:54:28
@article{e2726827-cef7-45ff-9e3f-bd601cb13a1b,
  abstract     = {{<p>OBJECTIVE: To explore dementia management from a primary care physician perspective.</p><p>DESIGN: One-page seven-item multiple choice questionnaire; free text space for every item; final narrative question of a dementia case story. Inductive explorative grounded theory analysis. Derived results in cluster analyses. Appropriateness of dementia drugs assessed by tertiary care specialist.</p><p>SETTING: Twenty-five European General Practice Research Network member countries.</p><p>SUBJECTS: Four hundred and forty-five key informant primary care physician respondents of which 106 presented 155 case stories.</p><p>MAIN OUTCOME MEASURES: Processes and typologies of dementia management. Proportion of case stories with drug treatment and treatment according to guidelines.</p><p>RESULTS: Unburdening dementia - a basic social process - explained physicians' dementia management according to a grounded theory analysis using both qualitative and quantitative data. Unburdening starts with Recognizing the dementia burden by Burden Identification and Burden Assessment followed by Burden Relief. Drugs to relieve the dementia burden were reported for 130 of 155 patients; acetylcholinesterase inhibitors or memantine treatment in 89 of 155 patients - 60% appropriate according to guidelines and 40% outside of guidelines. More Central and Northern primary care physicians were allowed to prescribe, and more were engaged in dementia management than Eastern and Mediterranean physicians according to cluster analyses. Physicians typically identified and assessed the dementia burden and then tried to relieve it, commonly by drug prescriptions, but also by community health and home help services, mentioned in more than half of the case stories.</p><p>CONCLUSIONS: Primary care physician dementia management was explained by an Unburdening process with the goal to relieve the dementia burden, mainly by drugs often prescribed outside of guideline indications. Implications: Unique data about dementia management by European primary care physicians to inform appropriate stakeholders. Key points Dementia as a syndrome of cognitive and functional decline and behavioural and psychological symptoms causes a tremendous burden on patients, their families, and society. •We found that a basic social process of Unburdening dementia explained dementia management according to case stories and survey comments from primary care physicians in 25 countries. •First, Burden Recognition by Identification and Assessment and then Burden Relief - often by drugs. •Prescribing physicians repeatedly broadened guideline indications for dementia drugs. The more physicians were allowed to prescribe dementia drugs, the more they were responsible for the dementia work-up. Our study provides unique data about dementia management in European primary care for the benefit of national and international stakeholders.</p>}},
  author       = {{Petrazzuoli, Ferdinando and Vinker, Shlomo and Palmqvist, Sebastian and Midlöv, Patrik and Lepeleire, Jan De and Pirani, Alessandro and Frese, Thomas and Buono, Nicola and Ahrensberg, Jette and Asenova, Radost and Boreu, Quintí Foguet and Peker, Gülsen Ceyhun and Collins, Claire and Hanževački, Miro and Hoffmann, Kathryn and Iftode, Claudia and Koskela, Tuomas H and Kurpas, Donata and Reste, Jean Yves Le and Lichtwarck, Bjørn and Petek, Davorina and Schrans, Diego and Soler, Jean Karl and Streit, Sven and Tatsioni, Athina and Torzsa, Péter and Unalan, Pemra C and Marwijk, Harm van and Thulesius, Hans}},
  issn         = {{0281-3432}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{3}},
  pages        = {{253--264}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Journal of Primary Health Care}},
  title        = {{Unburdening dementia: : a basic social process grounded theory based on a primary care physician survey from 25 countries}},
  url          = {{http://dx.doi.org/10.1080/02813432.2020.1794166}},
  doi          = {{10.1080/02813432.2020.1794166}},
  volume       = {{38}},
  year         = {{2020}},
}