Dementia and the role of the GP in the 21st century: the significance of rural general practice

Australia, like the rest of the developed world, is experiencing a dementia epidemic and the number of people with dementia will continue to burgeon over at least the next four decades. The results of this epidemic will be most keenly felt in rural areas where an increase in the proportion of people with dementia living in rural areas is expected, and where the capacity of already under-resourced rural communities to meet the health and wellbeing needs of this growing cohort will be further challenged.
 
   The GP plays a pivotal role in the provision of healthcare to older people, particularly in rural areas where access to other health professionals and services is limited, and it is expected that the rural GP will guide people with dementia and their carers through their journey. Evidence suggests that this guidance can be improved by increasing the rate of dementia detection and diagnosis: Undetected dementia has significant negative implications on the quality of life and death of those affected by the disease and their families.
 
   This study aimed to explore the impact of knowledge and experience, and the influence of attitude and confidence, on the decision making processes of rural GPs in the detection, diagnosis, disclosure and early management of dementia.

   This study also aimed to identify and describe the perceived barriers and enablers to dementia diagnosis and its disclosure in rural general practice. A mixed methods approach was utilised to both quantify the attitudes and confidence of GPs in detecting, diagnosing and disclosing the diagnosis of dementia through responses to statements on a questionnaire, and to qualify their responses with interview data to further explore GPs interpretation and constructed knowledge through their real world experiences.
 
   The results of this study add to the limited evidence base around barriers and enablers to the detection and diagnosis of dementia in rural general practice, and also contribute to the almost non-existent published evidence on the importance of the clinical reasoning process on the ability of the GP to detect, diagnose and disclose a diagnosis of dementia. The knowledge and experience of GPs with dementia as a disease process was explored, with evidence suggesting that the degree of knowledge and experience plays a large part in influencing the attitude and confidence of GPs in detecting, diagnosing and disclosing a diagnosis of dementia to the patient and their family. The study results indicate that GPs do tend to rely on their clinical reasoning skills in relation to dementia more so than with other illnesses such as cancer, and interventions for people with dementia are influenced by the outcome of this clinical reasoning process. Geographic location does not appear to influence the attitude and confidence of GPs as much as their gender and age does.
 
   In considering the results of this study, a number of opportunities to improve the diagnosis and management of dementia in rural general practice have been identified, and many of these opportunities could also relate to GPs working in metropolitan locations.