Iliffe Steve, Manthorpe Jill, Eden Alison
Royal Free and UCL Medical School, Rowland Hill Street, London NW3 2PF, UK.
Fam Pract. 2003 Aug;20(4):376-81. doi: 10.1093/fampra/cmg407.
The aim of this study was to explore the perspectives of primary care practitioners on the early diagnosis of dementia.
A total of 247 GPs, 146 community nurses, 36 practice nurses, 79 community mental health nurses and others working in a range of hospital, residential and community settings attended 24 one-day workshops in 21 cities and towns in the UK. A nominal group approach was used relating to the early diagnosis of dementia in the community.
Groups agreed on the benefits and risks of early diagnosis of dementia; disagreed about screening for dementia, and about professional resistance to making the diagnosis; constructed comprehensive guidelines on diagnosis, but without much reference to resource implications; yet described actual local resource limitations in detail; and avoided dilemmas about dementia care by framing it as a specialist activity.
Practitioners situate dementia in a family context but do not yet use a disablement model of dementia which might reduce tensions about early diagnosis and the disclosure of the diagnosis. The term diagnosis could usefully be replaced by recognition, to aid this shift in model. Service gaps may emerge or widen if earlier diagnosis of dementia is pursued as a policy objective.
本研究旨在探讨基层医疗从业者对痴呆症早期诊断的看法。
共有247名全科医生、146名社区护士、36名执业护士、79名社区心理健康护士以及其他在一系列医院、养老院和社区环境中工作的人员，参加了在英国21个城镇举办的24场为期一天的研讨会。采用名义小组法探讨社区中痴呆症的早期诊断。
各小组对痴呆症早期诊断的益处和风险达成了一致意见；在痴呆症筛查以及专业人员对做出诊断的抵触方面存在分歧；制定了全面的诊断指南，但对资源影响提及不多；详细描述了实际的当地资源限制；并将痴呆症护理视为一项专科活动，从而避免了相关困境。
从业者将痴呆症置于家庭背景中，但尚未采用痴呆症失能模型，而该模型可能会减少早期诊断及诊断披露方面的紧张关系。为有助于这种模型转变，“诊断”一词可用“识别”来有效替代。如果将痴呆症早期诊断作为政策目标，可能会出现或扩大服务差距。
