Table 1 Theme 1: GPs’ attitudes towards the diagnosis and management of cognitive impairment and dementia

“Why do I do it? Just part of your annual check-up, part of your sort of annual assessment. Everybody over 75 gets it once a year, and you do like cognitive assessment, whether or not they might have had any falls, you know, what’s happening at home, social assessment, sort of a general health assessment, basically an assessment of their nutrition.” – 2GP

1.1a

“Not as a screen, but I do see a lot, you know if there’s a trigger factor for it, like patients might have forgotten their appointment or they don’t seem to be taking their medications properly, or their spouse comes in with them and mentions trouble. Yeah, so I don’t have a system for running a cognitive screen on people.” – 12GP

1.1b

‘Patients come in and there are multiple complex [problems] these days and people want me to do ten problems in 15 min, so there’s not time.’ – 3GP

1.1c

‘Well I think the most important thing is to explain to the patient what’s going on with them so the patient is aware of the fact that you believe there’s a process taking place in their blame that is the reason why they’re having the symptoms they’re having, and explaining that to their family as well, so then you can treat them most effectively to manage the various aspects of the dementia.’ – 10GP

1.2a

‘It gives a name to what’s happening to them if they’ve noticed symptoms and a justification for any deficits they’re noticing. It also gives them time. If it’s mild cognitive impairment they’ve got time to put in strategies and to make some plans for the future in an informed way, which they can’t if it isn’t addressed.’ – 11GP

1.2b

‘And it certainly can be somewhat distressing for some people to feel that their mind’s not working as well as it should and certainly with mild cognitive impairment it does seem as though some people may show signs of that but not necessarily go on to dementia, and also that some processes are much slower or faster than others, so I find it a little bit of a vexed question when it seems at the early stages.’ – 6GP

1.2d

‘It is difficult because we don’t have that many treatments that are very effective, and so that it’s hard to diagnose something and then say “sorry, we haven’t got much we can do for you.”’ – 6GP

1.2e

‘I personally wouldn’t want to diagnose myself, I would want them to have like more testing and at least a CT scan in secondary care to try and make the diagnosis.’ – 9GP

1.3a

‘Yes, yeah. I think I feel that, I think I can make the diagnosis myself but – because it’s usually fairly clear when you do the assessment, but just for more, again for more detail on the cognitive scale … and also takes a little bit more time and specialists will have that.’ – 3GP

1.3c

‘We do require the services of specialists under the Commonwealth system requiring specialists to institute treatment which is pharmacological, pharmacotherapy for dementia, so clearly we need to refer for accessing treatments for dementia, pharmacological treatments that is.’ – 10GP

1.3d

‘Well dementia definitely, yes. If they’ve got dementia I do get that diagnosis confirmed by a specialist because I think that’s very important. With mild cognitive impairment well yes, I do yeah. Well yes, I make that diagnosis, yes.’ – 21GP

1.3e

‘Yeah, I think the management is the problem with – because obviously these people need a lot more support. I think the places they could go to that deal specifically with that, it would be much better, yeah.’ – 2GP

1.3f