Implementing a novel clinical decision support system to enhance identification of patients with dementia (DECODE): GP assessment of acceptability and feasibility

Problem

Diagnoses of dementia are often delayed and in some cases never made. A key driver behind this is the difficulty GPs have identifying who to refer to specialist memory clinics. At present only 40% of patients referred to memory clinics in Devon have dementia; waiting times are rapidly increasing, compounding the delays in the system and resulting in worse outcomes for patients. Our DEmentia identification COmputerised DEcision system (DECODE) has been rigorously developed to support clinicians in triaging patients. Operational research modelling suggests its implementation as a memory clinic triage system would reduce waiting times and release resources for post diagnostic support. We plan to implement DECODE locally and approached GPs to ascertain their views on the acceptability and feasibility of introducing DECODE both at memory clinic triage and in primary care.

Approach

We conducted three primary care focus groups incorporating twenty GPs from five practices, all of whom refer to Exeter Memory Clinic. DECODE was introduced and open discussion followed. The GPs then completed a structured questionnaire that captured demographic information and levels of confidence in dementia assessment before addressing acceptability and feasibility issues. Visual analogue scales from 0=low to 100=high were used to capture overall ratings of confidence, feasibility and acceptability.

Findings

The mean age of GPs was 46 (SD=10.0, range 31-76), and they had worked as a GP for a mean of 17 years (SD=9.1, range 3-40). Confidence in assessing patients with possible dementia was moderately high (mean rating 65/100, SD=18 range 29-88). More experienced GPs were similarly confident in assessing patients who might have dementia compared to their less experienced colleagues (r=-0.26 p=0.28). The majority (90%) thought using DECODE would enhance their confidence, and all but one (95%) would like to use DECODE in their clinical practice. Ratings for the acceptability (mean=89/100, SD=9.5, range 72-100) and feasibility (mean=80/100, SD=19.7, range 28-100) of implementation at memory clinic triage were high. The same was true of implementation in primary care with high ratings for acceptability (mean=82/100, SD=16.9, range 45-100) and feasibility (mean=80/100, SD=18.4, range 36-100). Ease of use, training needs and time management were identified through qualitative feedback as key themes to consider when DECODE is further developed and implemented.

Consequences

Twenty GPs have given us a clear indication that they consider it to be both acceptable and feasible to implement DECODE in memory clinics and primary care. This provides key evidence for our planned feasibility trial, implementing DECODE at memory clinic triage and in selected primary care practices in Devon. If this is successful we will be in a position to apply for a full cluster randomised trial of DECODE in primary care. We hope that this will ultimately benefit patients, carers and clinicians by facilitating accurate early dementia identification.