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Table 3 Educational needs assessment for dementia care in general practice

From: Developing an educational intervention on dementia diagnosis and management in primary care for the EVIDEM-ED trial

1. How would you rate your current care for people with dementia and their carers (using a simple scale of good enough/satisfactory/needs substantial improvement)? Answers will indicate whether focused educational input is needed or broader input (this is a very subjective assessment - the practice may be better or worse than it thinks). Gives the research team some sense of scale of need and time commitment, and may permit preliminary selection of learning materials and resources.
2. What grounds or criteria is your rating based on? Identifies more clearly the areas of strength and weakness, from practice perspective, for example, is the major problem with diagnosis, or disclosure of the diagnosis, or judging impairment, or knowing what the appropriate responses and resources are? Sense of priorities for learning will begin to emerge here.
3. Does the number of people in your practice diagnosed with dementia correlate with the local prevalence figures? Reflects local demography and under-recognition. GPs tend to overestimate prevalence and likely future workload, so some reframing possible (we need epidemiological data).
4. How do you arrive at your decision for diagnosis of dementia? Tells us about the diagnostic procedure followed in the practice. It will also inform us on who makes the diagnosis. Helps identify roles within the practice team. Skill mix and experiences within the group can then be shared between colleagues with the opportunity for peer to peer learning.
5. How many older people with suspected dementia did you refer last year? Reveals the practice culture (transfer of responsibility to specialist services versus GP care). We will know if we need to increase their capacity to provide GP care or simply reinforce existing good practice.
6. After diagnosis, what follow-up do you provide to people with dementia and their carers? Opens up discussion about systematisation of care within the practice and resources available to the practice. Provides knowledge on their case management methods as well as a local (and national) directory of resources.
7. Are you using a shared care protocol for cholinesterase inhibitors? If ‘yes’, then: (i) who was involved in producing the protocol; (ii) who is involved in its implementation (for example, hospital consultants, community psychiatric nurses, care of older people team) Awareness of protocol (if it exists), and its appropriateness for general practice. Rehearse use of (GP-developed) shared care protocol.
8. How effective do you think cholinesterase inhibitors are and how effective have you found them in your practice? Awareness of realistic likely impact of cholinesterase inhibitors. Discussion of trial data on cholinergic drug effects.
9. What non-pharmacological alternatives do you have available to help your patients (and their carers)? Will indicate extent of networking with local services as well as identify practice resources usable by people with dementia. Provision of information about cognitive reframing and other psychosocial support methods.
10. Based on your experience, what do you think are the important quality markers in caring for people with dementia? (What would you want for yourself?) Elicits both clinical and personal experience; may provide very useful case vignettes. Fit the practice’s conception of quality markers to the NICE/SCIE guideline indicators[40].
11. Is there anything that you would like improve? If yes, what is it and why would you like it to change? Prioritisation of learning needs. Highly focused educational input.
  1. GP: general practitioner; NICE: National Institute for Health and Clinical Excellence; SCIE: Social Care Institute for Excellence.