Wangler Julian, Jansky Michael
Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Mainz, Deutschland.
Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Mainz, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2022 Apr;169:75-83. doi: 10.1016/j.zefq.2021.12.009. Epub 2022 Feb 18.
General practitioners (GP) face major challenges in everyday practice when it comes to identifying dementia cases as early as possible under the condition of time and resource constraints. The involvement of the practice staff promises decisive advantages in detection and diagnosis. So far, there has been a lack of studies exploring the extent to which non-medical practice employees in general practices are integrated into dementia detection, what experiences they have had and how they assess their own potential to contribute to more efficient dementia detection.
Between August 2020 and August 2021, a total of 64 semi-structured, audio-technically recorded individual / expert interviews were conducted with non-medical practice employees (medical assistants) in general practices in all German federal states (four interviewees per federal state). The interview transcripts were evaluated using a qualitative, structuring content analysis according to Mayring (Software MAXQDA 2020).
The GP team members show a high degree of willingness and motivation to support the doctor in identifying and diagnosing dementia; situations have been reported where their assistance has led to an earlier identification of people with dementia. Observation and detection of dementia patients are rarely based on systematic criteria. On the whole, only some GPs entrust their staff with tasks like this. A large portion of the interviewees expressed considerable uncertainty regarding the assessment of possible signs of incipient dementia, which corresponds to the fact that only a minority of the interviewees have ever completed further training with a focus on dementia.
Practice staff can provide invaluable support when it comes to the timely and consistent detection of incipient dementia in general practice. In addition to sensitizing GPs and optimizing practice management, targeted training with regard to geriatric issues will be instrumental in achieving this. Accordingly, more advanced training formats should be developed that are tailored to the perspective of practice employees and convey important dementia-specific diagnostics, action and communication skills.
在日常诊疗中，全科医生（GP）在时间和资源受限的情况下尽早识别痴呆病例面临重大挑战。诊所工作人员的参与有望在检测和诊断方面带来决定性优势。到目前为止，缺乏研究探讨全科诊所的非医疗工作人员在多大程度上融入痴呆检测、他们有哪些经历以及他们如何评估自己对提高痴呆检测效率的贡献潜力。
在2020年8月至2021年8月期间，对德国所有联邦州的全科诊所的非医疗工作人员（医疗助理）进行了总共64次半结构化、有音频记录的个人/专家访谈（每个联邦州4名受访者）。根据迈林的方法（软件MAXQDA 2020），使用定性的、结构化的内容分析法对访谈记录进行评估。
全科医生团队成员表现出高度的意愿和积极性来支持医生识别和诊断痴呆；有报告称他们的协助导致了痴呆患者的更早识别。对痴呆患者的观察和检测很少基于系统标准。总体而言，只有一些全科医生将此类任务委托给他们的工作人员。很大一部分受访者对早期痴呆可能迹象的评估表示相当不确定，这与只有少数受访者完成过以痴呆为重点的进一步培训这一事实相符。
在全科医疗中及时、持续地检测早期痴呆方面，诊所工作人员可以提供宝贵的支持。除了提高全科医生的认识和优化诊所管理外，针对老年问题的定向培训将有助于实现这一目标。因此，应该开发更高级的培训形式，以适应诊所工作人员的视角，并传授重要的痴呆特异性诊断、行动和沟通技能。
