Background Most people living with dementia will experience behavioural and psychological symptoms of dementia (BPSD) such as aggression or agitation at some point in their illness. However, evidence suggests that the current management of BPSD in primary care is sub-optimal. Non-pharmacological strategies are recommended first-line in BPSD but uptake of these strategies is low. Despite their adverse effects and minimal effectiveness antipsychotics are frequently employed to manage BPSD. The aim of this study was to explore general practitioners (GPs) knowledge of and attitudes towards the management of BPSD with a view to informing future interventions.
Methods This was a descriptive cross-sectional study. An anonymous postal questionnaire was sent in May 2018 to a census sample of all GPs in two counties in southern region of Ireland; county Kerry and county Cork. The questionnaire was adapted from a previous study and piloted with three GPs. Based on the sample size calculations, 209 responses were required to adequately power the study. All responses were coded and SPPS v25 was used for statistical analysis.
Results Of the 456 questionnaires sent 168 completed questionnaires were returned representing a response rate of 36.8%. The sample was representative of GPs nationally. 62.5% (105/168) of respondents had a nursing home commitment. GPs unanimously believed that antipsychotics, benzodiazepines and antidepressants did not benefit all patients with BPSD. The majority of GPs (60.7%) agreed they required more training and experience to improve their management of BPSD. ‘Lack of resources in the primary care team’ was cited as the main barrier to GPs recommending non-pharmacological management for BPSD. However, 69% of GPs reported they routinely recommended non-pharmacological interventions before medication to manage BPSD. Nursing staff were identified as the group of people that most influenced the GPs prescribing of antipsychotic medications. The majority of respondents (52.4%, 84/168) said they did not have a repeat prescribing policy for patients with dementia on antipsychotics. 63.1% (106/168) of GPs were concerned that withdrawing medication would impact negatively on the quality of life of the person with dementia leading to a return of BPSD. No association was found between years of experience in primary care and confidence to withdraw medication in BPSD (p=0.25).
Conclusion This study identified several factors influencing the prescription of antipsychotics in BPSD as well as barriers to recommending non-pharmacological strategies. These findings can be used to guide future interventions aimed at improving the management of BPSD in primary care.
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