Practice constraints, behavioral problems, and dementia care

Primary care physicians' perspectives

W Ladson Hinton, Carol E. Franz, Geetha Reddy, Yvette Flores, Richard L Kravitz, Judith C. Barker

Research output: Contribution to journalArticle

116 Citations (Scopus)

Abstract

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 ≥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.

Original languageEnglish (US)
Pages (from-to)1487-1492
Number of pages6
JournalJournal of General Internal Medicine
Volume22
Issue number11
DOIs
StatePublished - Nov 2007

Fingerprint

Primary Care Physicians
Dementia
Interviews
Physicians
Physicians' Offices
Social Welfare
Family Physicians
Social Work
Problem Behavior
Pharmacology
Delivery of Health Care

Keywords

  • Barriers
  • Dementia
  • Qualitative
  • Quality of care

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Practice constraints, behavioral problems, and dementia care : Primary care physicians' perspectives. / Hinton, W Ladson; Franz, Carol E.; Reddy, Geetha; Flores, Yvette; Kravitz, Richard L; Barker, Judith C.

In: Journal of General Internal Medicine, Vol. 22, No. 11, 11.2007, p. 1487-1492.

Research output: Contribution to journalArticle

Hinton, W Ladson ; Franz, Carol E. ; Reddy, Geetha ; Flores, Yvette ; Kravitz, Richard L ; Barker, Judith C. / Practice constraints, behavioral problems, and dementia care : Primary care physicians' perspectives. In: Journal of General Internal Medicine. 2007 ; Vol. 22, No. 11. pp. 1487-1492.
@article{e821dacb4f134768b101e5bbcd40f7b5,
title = "Practice constraints, behavioral problems, and dementia care: Primary care physicians' perspectives",
abstract = "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 ≥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.",
keywords = "Barriers, Dementia, Qualitative, Quality of care",
author = "Hinton, {W Ladson} and Franz, {Carol E.} and Geetha Reddy and Yvette Flores and Kravitz, {Richard L} and Barker, {Judith C.}",
year = "2007",
month = "11",
doi = "10.1007/s11606-007-0317-y",
language = "English (US)",
volume = "22",
pages = "1487--1492",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "11",

}

TY - JOUR

T1 - Practice constraints, behavioral problems, and dementia care

T2 - Primary care physicians' perspectives

AU - Hinton, W Ladson

AU - Franz, Carol E.

AU - Reddy, Geetha

AU - Flores, Yvette

AU - Kravitz, Richard L

AU - Barker, Judith C.

PY - 2007/11

Y1 - 2007/11

N2 - 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 ≥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.

AB - 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 ≥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.

KW - Barriers

KW - Dementia

KW - Qualitative

KW - Quality of care

UR - http://www.scopus.com/inward/record.url?scp=35248866197&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=35248866197&partnerID=8YFLogxK

U2 - 10.1007/s11606-007-0317-y

DO - 10.1007/s11606-007-0317-y

M3 - Article

VL - 22

SP - 1487

EP - 1492

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 11

ER -