[Barriers in the care pathway of dementia diagnostics: framework analysis of the "iCreate" project]

In Germany around 1.8 million people live with dementia, with the numbers rising. Dementia is underdiagnosed. Although family practitioners (FP) are often the first point of contact for cognitive problems, the diagnosis is frequently delayed and mostly made in specialized centers. The "iCreate" project examined an optimized tablet-based case-finding approach to testing cognition. Patients with conspicuous results were referred to a memory clinic (MC) for differential diagnostics. Despite positive feedback regarding practical feasibility, various barriers in the care pathway of the project were identified. These are critically examined and possible solutions for improving a structured early detection process for dementia in the FP care are presented.

Secondary analysis of 21 qualitative interviews and 56 project protocols (telephone notes, email correspondences, team meeting protocols) from the "iCreate" project using framework analysis according to Spencer et al. [16].

Key barriers identified along the care pathway included: a) patient selection and approach were frequently restrained due to fear of stigmatization, b) lack of time and resources in FP practices and the MC, c) non-standardized procedures and organizational deficiencies in the care pathway (e.g., poor communication, difficult appointment scheduling) and d) high "no-show" rate of ca. 28% of the referred patients for diagnostic appointments in the MC.

The identified barriers highlight the need for action toward a structured and patient-centered dementia diagnostic process. Standardized procedures, interdisciplinary collaboration and training on sensitive communication are necessary.