"It's Usually Not Dementia That's the Focus": Barriers and Facilitators of Dementia Care in Primary Care.

Abstract

Primary care provides most dementia care, yet providing high-quality dementia care within this setting remains a challenge. Medicare and health system initiatives create opportunities to improve quality of dementia care. To evaluate barriers and facilitators of high-quality dementia care in primary care with a secondary focus on interdisciplinary team-based primary care and health information technology. Qualitative study using semi-structured interviews from July 2021 to January 2023. Fifteen persons living with dementia (PLWD) and/or their 13 family caregivers, five primary care providers (PCPs), and 23 interdisciplinary primary care staff (nurses, medical assistants, care managers, social workers, pharmacists, practice administrators) across practices in a single health system. We used qualitative content analysis to identify barriers and facilitators to dementia care within a framework of factors affecting whether clinicians follow clinical practice guidelines and how interdisciplinary teams and technology may support dementia care. Across all participants, there was limited knowledge of care practices and domains that constitute high-quality dementia care. Though PCP, staff, and caregiver attitudes were affected by their own prioritization of other medical conditions in primary care, all groups appreciated the importance of dementia care, and PCPs and staff were already addressing many relevant care domains. Barriers driving behavior were numerous and included time constraints, staffing challenges, and resource limitations in addition to patient or family-level factors. Interdisciplinary team-based care, telehealth, and patient portals can facilitate dementia care from PCP, staff, PLWD, and caregiver perspectives but interdisciplinary teams in particular are not yet used optimally. PCPs, interdisciplinary staff, PLWD, and caregivers identify numerous barriers to high-quality dementia care. Implementing dementia care and primary care initiatives, optimizing interdisciplinary team functioning, patient portal and telehealth use for dementia care, PCP/staff dementia training, and addressing well-known primary care challenges could improve dementia care in select settings.