Article type
Abstract
Background: Singapore has seen rising prevalence of dementia and the associated disease burden driven by an aging population. Primary care plays a pivotal role in ensuring sustainable care delivery in the community to people with dementia and their caregivers. However, gaps and variations of clinical practices were reported.
Objectives: We conducted formative research to understand current practice and barriers and enablers of practice change, with the aim to inform scoping of a proposed ACE Clinical Guidance (ACG) for primary care and to improve the likelihood of practice adoption.
Methods: Local publications and international guidelines on dementia management were identified and appraised through a systematic search on PubMed. To complement and triangulate findings from the literature, we additionally engaged primary care physicians (PCPs, n = 69) through a structured 14-item survey questionnaire and consulted with policy-making stakeholders.
Results: In line with international guideline recommendations, dementia is managed through both pharmacological and nonpharmacological approaches. Significant proportions of the surveyed PCPs did not prescribe pharmacotherapy (49%), nonpharmacological treatments (35%), or either of the two (25%) for their dementia patients, corroborating with the earlier reported gap that primary care participation in dementia management was low. This may be due to perceived challenges related to patients and caregivers (55%), unfamiliarity with treatment options (33%, eg, use of antipsychotics, and managing behavioral and psychological symptoms of dementia), negative perceptions of dementia care (28%, “time-consuming” as a frequent quote), and lack of access to a community multidisciplinary team (MDT, 26%). Private-sector PCPs, who assume around 80% of local primary care responsibilities, reportedly face more challenges than their counterparts practicing in public polyclinics, who are better supported with in-house memory clinics or community teamlet clinics.
Conclusions: The proposed ACG scope would focus on addressing knowledge gaps identified in primary care clinical management of dementia. Connecting private PCPs with community MDT resources may facilitate adoption, while engaging patients and caregivers during the ACG development may support addressing their unmet needs. From an implementation perspective, our findings inform national initiatives such as the National Dementia Strategy, which could address the system-related barriers through capability and infrastructure building and new care models development.
Objectives: We conducted formative research to understand current practice and barriers and enablers of practice change, with the aim to inform scoping of a proposed ACE Clinical Guidance (ACG) for primary care and to improve the likelihood of practice adoption.
Methods: Local publications and international guidelines on dementia management were identified and appraised through a systematic search on PubMed. To complement and triangulate findings from the literature, we additionally engaged primary care physicians (PCPs, n = 69) through a structured 14-item survey questionnaire and consulted with policy-making stakeholders.
Results: In line with international guideline recommendations, dementia is managed through both pharmacological and nonpharmacological approaches. Significant proportions of the surveyed PCPs did not prescribe pharmacotherapy (49%), nonpharmacological treatments (35%), or either of the two (25%) for their dementia patients, corroborating with the earlier reported gap that primary care participation in dementia management was low. This may be due to perceived challenges related to patients and caregivers (55%), unfamiliarity with treatment options (33%, eg, use of antipsychotics, and managing behavioral and psychological symptoms of dementia), negative perceptions of dementia care (28%, “time-consuming” as a frequent quote), and lack of access to a community multidisciplinary team (MDT, 26%). Private-sector PCPs, who assume around 80% of local primary care responsibilities, reportedly face more challenges than their counterparts practicing in public polyclinics, who are better supported with in-house memory clinics or community teamlet clinics.
Conclusions: The proposed ACG scope would focus on addressing knowledge gaps identified in primary care clinical management of dementia. Connecting private PCPs with community MDT resources may facilitate adoption, while engaging patients and caregivers during the ACG development may support addressing their unmet needs. From an implementation perspective, our findings inform national initiatives such as the National Dementia Strategy, which could address the system-related barriers through capability and infrastructure building and new care models development.