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. 2023 Sep 5;6(9):e2336030.
doi: 10.1001/jamanetworkopen.2023.36030.

Primary Care Practitioner Perspectives on the Role of Primary Care in Dementia Diagnosis and Care

Alissa Bernstein Sideman  1   2   3   4 , Melissa Ma  1 , Alma Hernandez de Jesus  1 , Cecilia Alagappan  4 , Na'amah Razon  5 , Daniel Dohan  1 , Anna Chodos  6 , Tala Al-Rousan  7 , Loren I Alving  8 , Freddi Segal-Gidan  9 , Howie Rosen  3 , Katherine P Rankin  3 , Katherine L Possin  3 , Soo Borson  10
Affiliations

Primary Care Practitioner Perspectives on the Role of Primary Care in Dementia Diagnosis and Care

Alissa Bernstein Sideman et al. JAMA Netw Open. .

Erratum in

  • Error in Title.
    [No authors listed] [No authors listed] JAMA Netw Open. 2023 Oct 2;6(10):e2342418. doi: 10.1001/jamanetworkopen.2023.42418. JAMA Netw Open. 2023. PMID: 37815835 Free PMC article. No abstract available.

Abstract

Importance: Although the barriers to dementia care in primary care are well characterized, primary care practitioner (PCP) perspectives could be used to support the design of values-aligned dementia care pathways that strengthen the role of primary care.

Objective: To describe PCP perspectives on their role in dementia diagnosis and care.

Design, setting, and participation: In this qualitative study, interviews were conducted with 39 PCPs (medical doctors, nurse practitioners, and doctors of osteopathic medicine) in California between March 2020 and November 2022. Results were analyzed using thematic analysis.

Main outcomes and measures: Overarching themes associated with PCP roles in dementia care.

Results: Interviews were conducted with 39 PCPs (25 [64.1%] were female; 16 [41%] were Asian). The majority (36 PCPs [92.3%]) reported that more than half of their patients were insured via MediCal, the California Medicaid program serving low-income individuals. Six themes were identified that convey PCPs' perspectives on their role in dementia care. These themes focused on (1) their role as first point of contact and in the diagnostic workup; (2) the importance of long-term, trusting relationships with patients; (3) the value of understanding patients' life contexts; (4) their work to involve and educate families; (5) their activities around coordinating dementia care; and (6) how the care they want to provide may be limited by systems-level constraints.

Conclusions and relevance: In this qualitative study of PCP perspectives on their role in dementia care, there was alignment between PCP perspectives about the core values of primary care and their work diagnosing and providing care for people living with dementia. The study also identified a mismatch between these values and the health systems infrastructure for dementia care in their practice environment.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Sideman reported receiving grants from the California Department of Public Health’s Alzheimer’s disease Program, from the National Institutes of Health (NIH) National Institute on Aging (NIA), from the NIH National Institute of Neurological Disorders and Stroke (NINDS), from the Health Resources and Services Administration, and from the California Department of Health Care Services outside the submitted work. Dr Segal-Gidan reported receiving personal fees from Eisai Pharmaceutical outside the submitted work. Dr Rosen reported receiving personal fees from Genentech and Eisai Pharmaceutical outside the submitted work. Dr Rankin reported receiving grants from the NIH and providing consultation on dementia care to Eli Lilly. Dr Possin reported receiving grants from NINDS and NIA during the conduct of the study. No other disclosures were reported.

References

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