Background: Primary care physicians (PCPs) play an important role in caring for persons with dementia. However, evidence shows that there is room for improvement regarding early recognition, supporting people with dementia and their caregivers, and arrangement of low-threshold services. The aim of this review is to identify interventions which address these aspects. Methods: We employed a systematic approach in accordance with standards proposed by the Cochrane Collaboration. The systematic search included resources available in the databases Medline, Embase, Cochrane, CINAHL, Psychinfo, ERIC, Scopus as well as Web of Science with no time restrictions. The review was conducted by two independent researchers at all stages with a third researcher for possible disagreement. Full-texts were excerpted and analyzed in accordance with international guidelines (PRISMA, BEME, CReDECI). Results: A total of 8409 titles/abstracts were identified and screened. After the exclusion of non-relevant publications 101 publications were analyzed for eligibility. After full-text screening 54 publications remained, supplemented by 24 publications from the reference lists. Seventy-eight full texts with PCPs were analyzed in detail, describing 56 projects with various interventional approaches: 1. Transfer of knowledge and skills: Provision of educational material like books or e-learning. The effects were comparatively low; in particular the effects were higher in combination with other inventions: Attendance-based seminars or the like with low effects. 2. Problem-based approaches directly addressing the PCPs (e.g., peer educational outreach visits or academic detailing) with moderate effects. 3. Interventions by changing the service pathway or by introducing case management approaches (also collaborative care and medical home models) with unclear effects. The majority of the projects used complex interventional approaches to improve the health care of people with dementia. With regard to the PCPs several studies point to the importance of attitudinal change instead of pure knowledge transfer. Conclusions: Overall, the effects of interventions were mostly moderate. Peer-to-peer techniques may be a solution to change the behavior of PCPs but these approaches are elaborated and resource intensive. It seems to be possible, that complex interventions which try to redesign services (e.g. collaborative care) may also change the behavior of PCPs.
Vollmar, H. C., Pentzek, M., Wilm, S., & Leve, V. (2016). P4-359: Interventions to Improve Primary Dementia Care. Alzheimer’s & Dementia, 12, P1175–P1175. https://doi.org/10.1016/j.jalz.2016.07.104