The DOI matches its Crossref record; 39 of the 39 references it cites were found in a registry or an index.
Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: a systematic review
Open accessAbstract
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.
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“Personal style, defined as the perceived fit between the intervention and the preferred style of clinical practice, such as clinicians’ communication style [78, 79], personality [54] and philosophical opposition to the intervention [69, 76], were presented exclusively as barriers.”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [79]
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“Perceptions of barriers may be socially constructed, and addressing them may not necessarily improve implementation [79].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [79]
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Hungarian general practitioners’ attitude and the role of education in dementia care
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“Such results are consistent with research that time constraints pose a barrier to GPs effectively identifying patients with dementia (Koch and Iliffe 2010).”
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“The benefit of early disease detection and treatment on the prevention of premature institutionalization has been demonstrated (Koch & Iliffe, 2010; Mittelman, Ferris, Shulman, Steinberg, & Levin, 1996).”
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“A recent review identified ‘therapeutic nihilism’ amongst GPs, the attitude that diagnosis is pointless because there are no available curative treatments, and so it could do more harm than good (Koch & Iliffe, 2010).”
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“This algins with findings of systematic reviews of physicianreported barriers to cognitive screening in primary care: healthcare providers fail to offer screenings when they perceive patient reluctance or concerns about the stigma of a diagnosis [43, 44].”
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“In contrast, an international review of GP practice by Koch and Iliffe (2010), found that many GPs perceived barriers in dementia diagnostics and care being due to barriers in the health care system, as opposed to deficits in their own skills and knowledge.”
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“But stigma and therapeutic nihilism on the part of HCPs are also recognised barriers.(14,33) However, GPs also describe a nuanced, cumulative process in which a dementia diagnosis in primary care evolves, to take account of the individual circumstances of each PLWD and their families.”
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Tablet-Based Outpatient Care for People With Dementia
Lech, S., O’Sullivan, J. L., Gellert, P. R., Voigt‐Antons, J., Greinacher, R., & Nordheim, J. (2019) · GeroPsych · doi:10.1024/1662-9647/a000210 · Cited by 8
Jena, A., Renjen, P. N., Taneja, S., Gambhir, A., & Negi, P. (2015) · Indian journal of radiology and imaging - new series/Indian journal of radiology and imaging/Indian Journal of Radiology & Imaging · doi:10.4103/0971-3026.169449 · Cited by 8
Visser, F. C. W., Kloppenburg-Lagendijk, M., Hempenius, L., Verwey, N. A., Perry, M., van Eersel, M. E. A., & Munster, B. C. V. (2025) · Age and Ageing · doi:10.1093/ageing/afaf176 · Cited by 10
Foley, T., Perry, M., & Robinson, L. A. (2025) · The Lancet Primary Care · doi:10.1016/j.lanprc.2025.100061 · Cited by 7
SafeHome: A Serious Game to Promote Safe Environments for Persons Living with Dementia
Appel, L., Peisachovich, E., Sinclair, D., Jokel, R., & Silva, C. D. (2020) · Cureus · doi:10.7759/cureus.6949 · Cited by 7
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de Hoyos-Alonso, M. C., Bonis, J., Bryant, V., Castell, M. V., & Puime, Á. O. (2015) · Atención Primaria · doi:10.1016/j.aprim.2015.03.002 · Cited by 7
“045) 13,5 (12,7-14,3)b 10,5 (9,9-11,2)b 11,9 (11,4-12,4)a 14,4 (13,3-15,4) 12,4 (11,3-13,6) 13,5 (12,7-14,3)a 12,4 (12,0-12,8)”
InfluentialPentzek, M., Michel, J. V., Ufert, M., Vollmar, H. C., Wilm, S., & Leve, V. (2015) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2015.03.005 · Cited by 6
Mayoral, V. F. D. S., Bôas, P. J. F. V., & Jacinto, A. F. (2021) · Arquivos de Neuro-Psiquiatria · doi:10.1590/0004-282x-anp-2020-0051 · Cited by 6
A systematic rapid evidence assessment of late diagnosis
Caird, J., Hinds, K., Kwan, I., & Thomas, J. (2012) · Cited by 6
The Annual Wellness Visit: Assessment of Cognitive Impairment
Loskutova, N. (2018) · Public Policy & Aging Report · doi:10.1093/ppar/pry047 · Cited by 6
Tan, W. J., Yeo, D. H. H., Koh, H. J., Wong, S. C., & Lee, T. M. (2020) · Dementia · doi:10.1177/1471301220967805 · Cited by 5
Creavin, S., Noel-Storr, A. H., Richard, E., Creavin, A. L., Cullum, S. J., Ben‐Shlomo, Y., & Purdy, S. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012558 · Cited by 6
Characteristics of nursing home residents with late-stage dementia and pain
Rostad, H. M., Grov, E. K., Utne, I., & Halvorsrud, L. (2020) · Sykepleien Forskning · doi:10.4220/sykepleienf.2019.79184en · Cited by 8
Exploring Healthcare Providers’ Views on Cognitive Assessment in Geriatric Care
Raju, N. (2024) · Annals of Pharmacy Education Safety and Public Health Advocacy · doi:10.51847/ohbxzj6ejx · Cited by 5
Empowering general practitioners in dementia care: The ANTISTIGMA education intervention in Europe
Cartz‐Piver, L., Calvet, B., Mehrabian-Spasova, S., Raycheva, M. R., Rejdak, K., Papuk, E., Leperre‐Desplanques, A., & Krolak‐Salmon, P. (2023) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5958 · Cited by 5
“enhancing GPs' perceptions of their ability to make the diagnosis, and the value of doing so in a timely manner.(32) In a meta‐analysis(33) authors considered that educational interventions that require active participation could improve detection of dementia but did not seem to increase adherence to dementia guidelin…”
BackgroundMcLaughlin, K., & Laird, L. (2019) · Mental Health Practice · doi:10.7748/mhp.2019.e1425 · Cited by 5
Validity and reliability of the Brain Health Self‐Efficacy Scale for the elderly
Gao, Y., Ming, C., Yang, C., Wu, Y., Long, Y., Chen, Y., Liu, H., Sun, L., Yang, Y., & Li, X. (2020) · General Psychiatry · doi:10.1136/gpsych-2020-100208 · Cited by 5
Lü, Y., Liu, C., Fawkes, S. A., Wang, Z., & Yu, D. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03175-4 · Cited by 8
Toller, G., Lorena, S., Dilaxy, K., Callahan, P. M., Köhn, F., Münzer, T., Kunze, U., Monsch, A. U., Possin, K. L., Rankin, K. P., et al. (2023) · Brain and Behavior · doi:10.1002/brb3.3329 · Cited by 5
“…there are several practice-level barriers around scheduling and expertise that may prevent physicians from evaluating cognition in routine clinical care (Kaduszkiewicz et al., 2010; Koch et al., 2010; Sabbagh et al., 2020), even in the presence of sensitive instruments such as the BHA and BHS.”
BackgroundSideman, A. B., Nguyen, H. Q., Langer-Gould, A., Lee, E. A., Borson, S., Shen, E., Tsoy, E., Macias, M., Goode, C., Rankin, K., et al. (2024) · BMC Primary Care · doi:10.1186/s12875-024-02544-9 · Cited by 4
“[3–5] Studies of the Medicare annual wellness visit, which requires detection of CI if present, have found inconsistent effects on detection, [6, 7] and very few published studies address other ways to improve detection of CI in primary care.”
BackgroundRühl, J., Brinkmann, S. T., Schaufler, D., Graessel, E., Walker, B. B., & Kolominsky‐Rabas, P. L. (2024) · Das Gesundheitswesen · doi:10.1055/a-2233-6168 · Cited by 4
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Lee, L. S., Weston, W. W., Hillier, L. M., Archibald, D., & Lee, J. J. (2018) · Gerontology & Geriatrics Education · doi:10.1080/02701960.2018.1484737 · Cited by 4
Assessing the Attitudes of Greek Nurses Toward Computerized Dementia Screening
Zygouris, S., Γκιόκα, Μ., Μoraitou, D., Teichmann, B., Tsiatsos, Τ., Papagiannopoulos, S., & Tsolaki, M. (2020) · Journal of Alzheimer s Disease · doi:10.3233/jad-200666 · Cited by 4
The nurse's role in closing the diagnostic gap for people with dementia
Leach, K., & Hicks, A. (2013) · British Journal of Community Nursing · doi:10.12968/bjcn.2013.18.9.433 · Cited by 4
Dementia Diagnostic Services for Ireland: a literature review
Reves, A., Timmons, S., Fox, S., Murphy, A., & O’Shea, E. (2018) · Lenus, The Irish Health Repository (Dr Steevens Hospital Library) · Cited by 4
Jacinto, A. F., Gordon, A. L., Samra, R., Steiner, A. B. Q., Mayoral, V. F. D. S., & Cítero, V. D. A. (2018) · Gerontology & Geriatrics Education · doi:10.1080/02701960.2018.1551216 · Cited by 4
“…Júlio de Mesquita Filho (Unesp), Botucatu, SP, Brazil © 2018 Taylor & Francis Group, LLC A systematic review on the barriers to diagnosis and management of dementia patients in primary care found that GPs internationally reported inadequate dementia training and education (Koch & Iliffe, 2010).”
BackgroundResource Utilization in Dementia a Question of Collaboration
Jedenius, E. (2010) · Figshare · Cited by 4
Ashbourne, J. (2015) · UWSpace (University of Waterloo) · Cited by 4
Stepleman, L. M., Penwell-Waines, L., & Valvano, A. K. (2015) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2015.1063059 · Cited by 4
“…example, if a specialty psychiatric care clinic has a reputation for long wait times for a new patient appointment, this might decrease a referring provider’s inclination to act expeditiously on the patient’s behalf during a busy clinic (Hartley, Korsen, Bird, & Agger, 1998; Koch & Iliffe, 2010).”
BackgroundHwang, J. J., Donnelly, T. T., Bouchal, S. R., & Davidson, S. (2023) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12932 · Cited by 3
Al-Awad, F. A., Al-Zahrani, M. A., Bawazeer, A. O., Al-Qahtani, F. S., Al-Jabari, S. A., Jayaseeli, N., AlAbdulKader, A. M., Alharkan, K. S., Al-Shammari, M. O., Mohammedin, A. S., et al. (2024) · Journal of Family and Community Medicine · doi:10.4103/jfcm.jfcm_230_23 · Cited by 5
The Management of Dementia in Primary Care
Vreese, L. P. D., Salvatore, L. D., Rovesta, L., & Fabbo, A. (2016) · InTech eBooks · doi:10.5772/62762 · Cited by 3
Metadata
- Authors
- the EVIDEM-ED project, Koch, T., & Iliffe, S.
- Affiliations
- The Royal Free Hospital (GB)
- Corresponding author
- Koch, Tamar
- ORCID
- Iliffe, Steve
- Venue
- BMC Family Practice
- Published
- 2010-07-01
- Volume
- 11
- Issue
- 1
- Pages
- 52-52
- ISSN
- 1471-2296 (ISSN-L)
- PMC
- PMC2909966
- OpenAlex
- W2049017668
- Cited by
- 275
- References
- 39
- Citations by year
- 2026: 15 · 2025: 19 · 2024: 15 · 2023: 12 · 2022: 25 · 2021: 15 · 2020: 26 · 2019: 24 · 2018: 23 · 2017: 8 · 2016: 11 · 2015: 19 · 2014: 15 · 2013: 23 · 2012: 15
- FWCI
- 2.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Family Practice (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute for Health and Care Research (RP-PG-0606-1005)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- dementia, barriers to diagnosis, early detection, primary care, general practitioners, dementia stigma, diagnostic uncertainty, diagnosis disclosure, general practice training, time constraints, financial constraints, National Dementia Strategy, dementia management
- MeSH terms
- Attitude of Health Personnel, Dementia, Humans, Primary Health Care, Disease Management, Early Diagnosis
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