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

Petrazzuoli, Ferdinando, Vinker, Shlomo, Palmqvist, Sebastian, Midlov, Patrik, De Lepeleire, Jan, Pirani, Alessandro, Frese, Thomas, Buono, Nicola, Ahrensberg, Jette, Asenovai, Radost, Boreu, Quintı Foguet, Peker, Gulsen Ceyhun, Collins, Claire, Hanzevacki, Miro, Van Marwijk, Harm and others, (2020) Unburdening dementia – a basic social process grounded theory based on a primary care physician survey from 25 countries. Scandinavian Journal of Primary Health Care, 38 (3). pp. 253-264. ISSN 0281-3432

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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 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.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Primary Care and Public Health
SWORD Depositor: Mx Elements Account
Depositing User: Mx Elements Account
Date Deposited: 26 Aug 2020 07:45
Last Modified: 26 Aug 2020 08:00
URI: http://sro.sussex.ac.uk/id/eprint/93278

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