Abstract
Background
More than 48,000 people in Ireland are living with dementia, and the number is likely to rise to 130,000 by 2041. Dementia frequently remains undiagnosed, depriving many of early interventions and the opportunity to plan for the future. Neuroimaging is helpful in the diagnosis of dementia, yet it is often insufficiently utilised. General practitioners (GPs) often decide which patients should be referred on for specialist assessment and as such play a crucial role in dementia diagnosis.
Aims
To establish the accessibility of neuroimaging in dementia by GPs, current referral patterns, confidence in referral and opinions on radiology reports.
Methods
The research design was a postal survey among GPs in single and group practices in urban, rural and semi-rural areas in the east and southeast of Ireland. GPs were identified from the Irish Medical Directory and posted individual anonymous questionnaires.
Results
A third of participants reported that they had no direct access to neuroimaging. Access differed between public and private patients. GPs primarily referred to computed tomography and magnetic resonance imaging, but only 14.6 % based these referrals on published guidelines. A total of 47.8 % of participants were not very confident in their ability to choose the most appropriate modality.
Conclusion
Access to neuroimaging investigations for suspected cases of dementia varies between locations and public and private systems. To improve diagnostic rates and ensure appropriate utilisation of imaging resources, GPs require access to clinical and referral guidelines to ensure appropriate use of neuroimaging and the best possible patient outcomes.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Department of Health (2014) The Irish National dementia strategy. http://health.gov.ie/wp-content/uploads/2014/12/30115-National-Dementia-Strategy-Eng.pdf. Accessed 4 May 2015
National Audit Office (2007) Improving services and support for people with dementia. The Stationery Office. http://www.nao.org.uk/wp-content/uploads/2007/07/0607604.pdf. Accessed 4 May 2015
Cahill S, O’Shea E, Pierce M (2012) Creating excellence in dementia care: a research review for Ireland’s national dementia strategy. Trinity College Dublin, Dublin
Matthews FE, Arthur A, Barnes LE, Bond J, Jagger C, Robinson L et al (2013) A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England. Lancet 382:1405–1412
Prince M, Guerchet M, Prina M (2013) The global impact of dementia 2013–2050. Alzheimer’s Disease International, London
Larson EB, Yaffe K, Langa KM (2013) New insights into the dementia epidemic. N Engl J Med 369:2275–2277
Alzheimer’s Society (2012) Mapping the dementia gap. http://www.alzheimers.org.uk/site/scripts/download_info.php?downloadID=554. Accessed 4 Nov 2013
Prince M, Bryce R, Ferri C (2011) World Alzheimer Report 2011: the benefits of early diagnosis and intervention. Alzheimer’s Disease International, London
Health Quality Ontario (2014) The appropriate use of neuroimaging in the diagnostic work-up of dementia. Ont Health Technol Assess Ser 14(1):1–64
National Institute for Health and Clinical Excellence (2007) Dementia: a NICE–SCIE Guideline on supporting people with dementia and their carers in health and social care. National Institute for Health and Clinical Excellence Social Care Institute for Excellence, London
Tartaglia MC, Rosen HJ, Miller BL (2011) Neuroimaging in dementia. Neurotherapeutics 8:82–92
Frisoni G, Fox N, Clifford R, Scheltens P, Thompson P (2010) The clinical use of structural MRI in Alzheimer disease. Nat Rev Neurol 6(2):67–77
Alzheimer’s Association (2013) 2013 Alzheimer’s disease facts and figures. Alzheimers Dement 9(2):208–245
Drago V, Babiloni C, Bartres-Faz D, Caroli A, Bosch B, Hensch T et al (2011) Disease tracking markers for alzheimer’s disease at the prodromal (MCI) stage. J Alzheimers Dis 26:159–199
NICE/SCIE (2006) Dementia: supporting people with dementia and their carers in health and social care. National Institute for Health and Clinical Excellence, Manchester
Foley T, Swanwick G (2014) Dementia: diagnosis and management in general practice. Irish College of General Practitioners. http://www.icgp.ie/go/library/icgp_publications/quick_reference_guides/E58DDB1B-B7B8-9694-7C170D04919D8699.html. Accessed 24 Apr 2015
White PM, Halliday-Pegg JC, Collie DA (2002) Open access neuroimaging for general practitioners—diagnostic yield and influence on patient management. Br J Gen Pract 52:33–35
Collie DA, Sellar RJ, Steyn JP, Cull RE (1999) The diagnostic yield of magnetic resonance imaging (MRI) of the brain and spine requested by general practitioners: comparison with hospital clinicians. Br J Gen Pract 49:559–561
Simpson GC, Forbes K, Teasdale E, Tyagi A, Santosh C (2010) Impact of GP direct-access computerised tomography for the investigation of chronic daily headache. Br J Gen Pract 60:897–901
O’Connell H (2012) A national dementia strategy for Ireland: signposting the possibilities. A Clinician’s Perspective Dublin, Ireland
Health Information and Quality Authority (2011) Report and recommendations on patient referrals from general practice to outpatient and radiology services, including the national standard for patient referral information. Health Information and Quality Authority, Dublin
Wilcock J, Iliffe S, Turner S, Bryans M, O’Carroll R, Keady J et al (2009) Concordance with clinical practice guidelines for dementia in general practice. Aging Ment Health 13(2):155–161
O’Riordan M, Collins C, Doran G (2013) Access to diagnostics: a key enabler for a primary care led health service. ICGP, Dublin
Commission Audit (2002) Forget me not 2002: developing mental health services for older people in England. Audiot Commission, London
Department of Health (2009) Living well with dementia: a national strategy. Department of Health, London
Scally G, Donaldson LJ (1998) Clinical governance and the drive for quality improvement in the new NHS in England. BMJ 317:61
Waldemar G, Phung K, Burns A, Georges J, Hansen F, Iliffe S et al (2007) Access to diagnostic evaluation and treatment for dementia in Europe. Int J Geriatr Psychiatry 22:47–54
Cahill S, Clark M, Walsh C, O’Connell H, Lawlor B (2006) Dementia in primary care: the first survey of Irish general practitioners. Int J Geriatr Psychiatry 21:319–324
Grieve FM, Plumb AA, Khan SH (2010) Radiology reporting: a general practitioner’s perspective. Br J Radiol 83:17–22
Gunn AJ, Sahani DV, Bennett SE, Choy G (2013) Recent measures to improve radiology reporting: perspectives from primary care physicians. J Am Coll Radiol 10(2):122–127
The Competition Authority (2009) General medical practitioners: part I: overview of the GP profession. The Competition Authority, Dublin
O’Dowd T, O’Kelly M, O’Kelly F (2006) Structure of general practice in Ireland: 1982–2005. Irish College of General Practitioners, Dublin
Acknowledgments
The authors gratefully acknowledge Dr Catherine Quinn and Professor Linda Clare for their contribution to the questionnaire design, Mr James Durkan for producing the database of general practitioners which facilitated the survey, and the support of the participating general practitioners.
Conflict of interest
The project has been part funded by the European Regional Development Fund through the Ireland Wales Programme 2007–13. There are no conflicts of interests.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ciblis, A.S., Butler, ML., Bokde, A.L.W. et al. The use of neuroimaging in dementia by Irish general practitioners. Ir J Med Sci 185, 597–602 (2016). https://doi.org/10.1007/s11845-015-1315-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-015-1315-4