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Family physicians and dementia in Canada

Part 1. Clinical practice guidelines: awareness, attitudes, and opinions

Malini Persaud, MN PhD
Doctoral candidate in the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto at the time of the study

Neil Drummond, PhD HonMFPHM(UK)
Associate Professor and Director of Research in the Department of Family Medicine at the University of Calgary in Alberta

Carole A. Cohen, MD FRCPC
Associate Professor in the Department of Psychiatry at the University of Toronto

James L. Silvius, MD FRCPC
Regional Chief for the Division of Geriatric Medicine at the University of Calgary

Karen Seigel, MD CCFP
Family physician in Calgary and participates in research with the Department of Family Medicine at the University of Calgary

Gary R. Hollingworth, MD CCFP FCFP
Associate Professor in the Department of Family Medicine at the University of Ottawa in Ontario

William B. Dalziel, MD FRCPC
Chief of the Ottawa Regional Geriatric Assessment Program

Correspondence: Dr Nicholas Pimlott, Women’s College Hospital, 60 Grosvenor St, Toronto, ON M5S 1B6; telephone 416 323-6400, extension 4581; fax 416 323-6351; e-mailnick.pimlott{at}utoronto.ca

OBJECTIVE To assess Canadian family physicians’ awareness of, attitudes toward, and use of the 1999 Canadian Consensus Conference on Dementia (CCCD) clinical practice guidelines (CPGs); to explore the barriers and enablers to implementing dementia CPGs in clinical practice; and to identify more effective strategies for future dementia guideline development and dissemination.

DESIGN Qualitative study using focus groups.

SETTING  Academic family practice clinics in Calgary, Alta, Ottawa, Ont, and Toronto, Ont.

PARTICIPANTS  Eighteen family physicians.

METHODS Using a semistructured interview guide, we conducted 4 qualitative focus groups of 4 to 6 family physicians whose practices we had audited in a previous study. Transcripts were coded using an inductive data analytic strategy, and categories and themes were identified and described using the principles of thematic analysis.

MAIN FINDINGS  Four major themes emerged from the focus group discussions. Family physicians 1) were minimally aware of the existence and the detailed contents of the CCCD guidelines; 2) had strong views about the purposes of guidelines in general; 3) expressed strong concerns about the role of the pharmaceutical industry in the development of such guidelines; and 4) had many ideas to improve future dementia guidelines and CPGs in general.

CONCLUSION Family physicians were minimally aware of the 1999 CCCD CPGs. They acknowledged, however, the potential of future CPGs to assist them in patient care and offered many strategies to improve the development and dissemination of future dementia guidelines. Future guidelines should more accurately reflect the day-to-day practice experiences and challenges of family physicians, and guideline developers should also be cognizant of family physicians’ perceptions that pharmaceutical companies’ funding of CPGs undermines the objectivity and credibility of those guidelines.

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				N. J.G. Pimlott, M. Persaud, N. Drummond, C. A. Cohen, J. L. Silvius, K. Seigel, G. R. Hollingworth, and W. B. Dalziel Family physicians and dementia in Canada: Part 2. Understanding the challenges of dementia care Can Fam Physician, May 1, 2009; 55(5): 508 - 509.e7. [Abstract] [Full Text] [PDF]