Challenges in detecting and managing mild cognitive impairment in primary care: a focus group study in Shanghai, China. Issue 9 (20th September 2022)

• Record Type: Journal Article
• Authors: Lu, Yuan; Liu, Chaojie; Wells, Yvonne; Yu, Dehua
• Is Part Of: BMJ open. Volume 12:Issue 9(2022)
• Publication Date: 2022-09-20
• Subjects: primary care -- qualitative research -- delirium & cognitive disorders; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2022-062240
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Introduction: Detection of mild cognitive impairment (MCI) is essential in slowing progression to dementia. Primary care plays a vital role in detecting and managing MCI. The chronic care model (CCM) provides effective methods to manage chronic diseases. Objective: This study aimed to explore how MCI services are delivered in primary care in China. Methods: Focus group interviews were conducted face to face among MCI stakeholders from six community health centres (CHCs) involved in the 'friendly community programme' in Shanghai, China. A total of 124 MCI stakeholders were interviewed, consisting of 6 groups (n=42) of general practitioners (GPs), 3 groups (n=18) of CHC managers, 4 groups (n=32) of people with MCI and 4 groups (n=32) of informal caregivers. Content and thematic analyses were performed using a combination of induction and deduction approaches. Results: Three major themes emerged from the data corresponding to the CCM framework: hesitant patients, unprepared providers and misaligned environments. While the public are hesitant to seek medical attention for MCI problems, due to misunderstanding, social stigma and a lack of perceived benefits, GPs and CHCs are not well prepared either, due to lack of knowledge and a shortage of GPs, and a lack of policy, funding and information support. None of these issues can be addressed separately without tackling the others. Conclusion: This study combined the diverse perceptions of all the main stakeholders to detect and manage MCI in primary care settings in China. A vicious circle was found among the three interconnected CCM domains, creating a gridlock that should be addressed through a system's approach targeting all of the above-mentioned aspects.