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Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: a systematic review

机译：对初级保健中痴呆患者的诊断和治疗障碍的快速评估：系统评价

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Background The diagnosis of dementia in primary care is perceived as a problem across countries and systems, resulting in delayed recognition and adverse outcomes for patients and their carers. Improving its early detection is an area identified for development in the English National Dementia Strategy 2009; there are thought to be multiple benefits to the patient, family, and resources by doing this. The aim of this review was to carry out a rapid appraisal in order to inform the implementation of this policy. Method Publications in English up to August 2009 relating to barriers to the recognition of dementia, were identified by a broad search strategy, using electronic databases MEDLINE, EMBASE, and psycINFO. Exclusion criteria included non-English language, studies about pharmacological interventions or screening instruments, and settings without primary care. Results Eleven empirical studies were found: 3 quantitative, 6 qualitative, and 2 with mixed methodologies. The main themes from the qualitative studies were found to be lack of support, time constraints, financial constraints, stigma, diagnostic uncertainty, and disclosing the diagnosis. Quantitative studies yielded diverse results about knowledge, service support, time constraints, and confidence. The factors identified in qualitative and quantitative studies were grouped into 3 categories: patient factors, GP factors and system characteristics. Conclusion Much can still be done in the way of service development and provision, GP training and education, and the eradication of stigma attached to dementia, to improve the early detection and management of dementia. Implementation of dementia strategies should include attention to all three categories of barriers. Further research should focus on their interaction, using different methods from studies to date.
机译：背景技术在各个国家和系统中，初级保健中的痴呆症诊断被认为是一个问题，导致对患者及其护理人员的延迟识别和不良后果。 《 2009年英国国家老年痴呆症战略》确定了需要早期开发的领域，以改善其早期发现;这样做可以为患者，家人和资源带来多重好处。审查的目的是进行快速评估，以告知该政策的实施情况。截止到2009年8月，英语方法出版物涉及广泛的搜索策略，使用电子数据库MEDLINE，EMBASE和psycINFO来识别与痴呆识别障碍有关的方法。排除标准包括非英语语言，有关药理干预措施或筛查仪器的研究以及无初级保健的环境。结果发现11项实证研究：3项定量，6项定性和2项混合方法。定性研究的主要主题是缺乏支持，时间限制，财务限制，污名，诊断不确定性和公开诊断。定量研究得出有关知识，服务支持，时间限制和信心的各种结果。定性和定量研究中确定的因素分为三类：患者因素，GP因素和系统特征。结论在服务开发和提供，全科医生培训和教育以及消除痴呆所致的污名等方面，仍可以做很多工作，以改善痴呆的早期发现和管理。痴呆症策略的实施应包括对所有三类障碍的关注。迄今为止，应使用不同的方法，进一步研究应关注它们之间的相互作用。

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