Practice constraints, behavioral problems, and dementia care: primary care physicians' perspectives
Open accessAbstract
Objectives To examine how practice constraints contribute to barriers in the health care of persons with dementia and their families, particularly with respect to behavioral aspects of care.Design Cross-sectional qualitative interview study of primary care physicians.Setting Physicians' offices.Participants Forty primary care physicians in Northern California.Measurements Open-ended interviews lasted 30-60 minutes and were structured by an interview guide covering clinician background and practice setting, clinical care of a particular patient, and general approach to managing patients with AD or dementia. Interviews were transcribed and themes reflecting constraints of practice were identified through a systematic coding process.Results Recurring themes (i.e., those present in > or = 25% of physician interviews) included insufficient time, difficulty in accessing and communicating with specialists, low reimbursement, poor connections with community social service agencies, and lack of interdisciplinary teams. Physician narratives suggest that these constraints may lead to delayed detection of behavior problems, "reactive" as opposed to proactive management of dementia, and increased reliance on pharmacological rather than psychosocial approaches.Conclusion Physicians often feel challenged in caring for dementia patients, particularly those who are more behaviorally complex, because of time and reimbursement constraints as well as other perceived barriers. Our results suggest that more effective educational interventions (for families and physicians) and broader structural changes are needed to better meet the needs of the elderly with dementia and their families now and in the future. Without these changes, dementia care is likely to continue to fall short.
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Commonly used cognitive assessments take time and training to administer, interpret, document and follow up on, which makes them hard to use in a busy practice setting.
“For instance, commonly used cognitive assessments take time and training to administer, interpret, document and follow up on, which makes them hard to use in a busy practice setting.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [717]
The Results say physicians struggle to fit dementia care into a 15-minute visit, and one physician says they do not perform an exhaustive mental examination at every visit. The Introduction also mentions limited confidence in dementia assessment skills. Neither passage establishes that commonly used cognitive assessments require time and training for administration, interpretation, documentation, and follow-up. (LLM, conf=0.83)
Experimental — accuracy not yet measuredLarge language models can enable conversational agents to interview patients efficiently and empathetically, adjust explanations to a patient's education level, and speak in most patients' preferred languages.
“LLMs can enable conversational agents to interview patients efficiently and empathetically,26 adjust explanations to a patient’s education level, and speak in most patients’ preferred languages.27”
From Review of Artificial Intelligence for Clinical Use in Alzheimer's Disease and Related Dementias (2026) · cites this paper as [27]
The Discussion (page unavailable) reports that families needing translators faced delays and that few non-Latino physicians spoke Spanish or had onsite translators. It does not address whether LLM agents can speak patients’ preferred languages or tailor explanations to education level. Searches for those capabilities found no supporting passage. (LLM, conf=0.77)
Experimental — accuracy not yet measuredAI-powered conversational agents, especially those using large language models, are showing the capabilities needed to gather an effective patient history.
“AI-powered conversational agents are demonstrating the capabilities needed to gather an effective patient history, particularly using LLMs.”
From Review of Artificial Intelligence for Clinical Use in Alzheimer's Disease and Related Dementias (2026) · cites this paper as [27]
The Design and Methods section describes interviews with physicians, while the Results discuss obtaining histories from family members of patients with dementia; no page numbers are available in our copy. Searches for AI-powered conversational agents, LLMs, chatbots, and automated patient-history gathering found no passage addressing the claim. (LLM, conf=0.78)
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References 40 · Cited by 268
Research works printed but not linked: 4
- [1]1. Cummings JL, Frank JC, Cherry D, et al. Guidelines for managing Alzheimer's Disease: Part I. Assessment. Am Fam Phys. 2002;65 (11):2263-72.
- [6]6. Hinton L, Haan M, Geller S, Mungas D. Neuropsychiatric symptoms in Latino elderly with dementia and mild cognitive impairment without dementia and factors that modify their impact on caregivers. Gerontol- ogist. 2003;43(5):669-77.
- [12]12. Vickrey BG, Mittman BS, Connor KI, et al. The effect of a disease management intervention on quality and outcomes of dementia care. Ann Intern Med. 2006;145:713-26.
- [19]19. Hinton W, Guo Z, Hillygus J, Levkoff S. Working with culture: a qualitative analysis of barriers to recruitment in dementia research among Chinese families. J Cross-Cult Gerontol. 2000;15:119-137.
- Authors
- Hinton, L., Franz, C. E., Reddy, G., Flores, Y., Kravitz, R. L., & Barker, J. C.
- Affiliations
- University of California Davis Medical Center (US)
- University of California San Diego (US)
- University of California, Los Angeles (US)
- University of California, Davis (US)
- University of California, San Francisco (US)
- Corresponding author
- Franz, Carol E.
- Venue
- Journal of General Internal Medicine
- Published
- 2007-09-07
- Volume
- 22
- Issue
- 11
- Pages
- 1487-1492
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2219799
- OpenAlex
- W1980754242
- Cited by
- 268
- References
- 40
- Citations by year
- 2026: 11 · 2025: 22 · 2024: 27 · 2023: 12 · 2022: 15 · 2021: 12 · 2020: 15 · 2019: 19 · 2018: 20 · 2017: 18 · 2016: 10 · 2015: 8 · 2014: 13 · 2013: 12 · 2012: 8
- FWCI
- 6.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of California, Davis
- National Institute on Aging (P30AG010129, R01AG012975, R03AG020343, R01AG022982, K23AG019809, R01AG0223815, K-23 AG19809, R01AG018386)
- National Institute of Mental Health (K24 MH7256)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- dementia care, behavioral symptoms of dementia, primary care physicians, barriers to care, Alzheimer's disease, physician time constraints, reimbursement, specialist referral, community social services, interdisciplinary teams, psychosocial interventions, family caregivers
- MeSH terms
- Adult, Aged, Aged, 80 and over, Alzheimer Disease, California, Communication, Decision Making, Dementia, Diagnosis-Related Groups, Female, Health Services Accessibility, Humans, Interprofessional Relations, Male, Middle Aged, Patient Care Team, Practice Patterns, Physicians', Primary Health Care, Time, Caregivers, Health Care Surveys, Qualitative Research
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