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RACGP calls for clear pathways and support in dementia care
The college has provided feedback as an overhaul of the decade-old dementia guidelines for best practice clinical care is underway.
The RACGP is calling for clear pathways, practical guidance, and appropriate support for GPs, as updated national clinical guidance on dementia care is underway.
Appropriate funding, equitable access to services, clearly defined care pathways, and guidance reflecting the realities of clinical practice.
These are among key considerations guiding the RACGP’s submission to the update of the Dementia clinical practice guidelines and principles of care.
Led by Monash University, the update aims to ensure the latest evidence-based guidance remains at the frontline of dementia risk reduction, diagnosis, and management – as ‘much research has been undertaken’ to improve understanding, practice and treatments since the previous Australian guidelines were developed in 2016.
The RACGP highlights that with general practice the most frequent first point of contact for people experiencing cognitive concerns, clear pathways, practical guidance, and appropriate support are significant implications to consider in the new guidelines.
‘GPs play a central role in the recognition, diagnosis, management and coordination of dementia care,’ the submission states.
‘This includes clinical assessment and identifying changes in cognition and function, facilitating access to appropriate services, and provide ongoing, person-centred support to patients, carers and families. GPs also coordinate multidisciplinary care, support care planning and referrals, and ensure continuity of care in response to the patient’s changing needs over time.’
The college says successful implementation of the guidelines will come down to appropriate funding, equitable access to services, specialist support, clearly defined care pathways, and guidance reflecting ‘the realities of clinical practice’.
These recommendations come as the World Health Organization this month released its first update in seven years on dementia prevention in primary care, detailing ‘early awareness and timely action’ of behaviour and lifestyle interventions to reduce risk.
In Australia, dementia causes the greatest burden of disease for people older than 65 and the second leading cause of burden of disease overall. It is the national leading cause of death, and as the population continues to grow and age, the number of Australians living with dementia is expected to more than double over the next 30 years.
In its submission, the RACGP notes several considerations for the updated clinical guidelines, including:
- not relying on services that are unevenly available or costly but instead having clear pathways, funding and adequate system supports to help consistent implementation across all settings
- workforce availability
- specifying where some services are not currently Medicare-funded to support clearer expectations for implementation
- acknowledging that GPs may be unable to independently initiate, interpret or manage specialist pathways in the absence of clearly defined referral processes and access to specialists.
‘Consideration should also be given to consultation time constraints in general practice, administrative requirements, and the complexity of coordinating referrals and supporting patients, carers and families in routine practice,’ it states.
Noting it may not be within the scope of the guidelines, the college says there is no guidance on clear referral pathways and ‘limited guidance on how or when to offer’ cognitive testing as a screening approach.
Gaps in routine primary care prevention and management are also flagged by the college, which says ‘pragmatic tasks’ including cardiovascular risk factor assessment, lifestyle interventions, vaccinations, and structured care frameworks such as chronic condition management plans need to be covered to improve care.
Also among the RACGP’s recommendations are diagnostic approaches and post-diagnostic care. These include blood-based biomarker testing, with GPs providing advice on the potential benefits, limitations and costs to patients and refer for testing where appropriate.
‘While these tests have the potential to improve equity, these are currently offered as private pathology services and costs can be prohibitive,’ it says.
‘As such, access to blood-based biomarker tests remains limited and appropriate MBS funding and the development of accessible pathways will need to be available to ensure equity as uptake will depend on financial affordability and geographic accessibility.’
The role of primary care should also be considered in facilitating appropriate access to tests, the college says, with GPs well placed to use these tests as part of the diagnostic pathway to streamline referrals, reduce unnecessary specialist demand, and support more timely access to care – providing they have appropriate education and support.
In addition, GPs’ longitudinal relationship means they are central to driving informed decision-making about testing.
‘A confirmed diagnosis may influence individual decision-making, including advance care planning and engagement with support services, and therefore represents a meaningful change in management,’ the submission states.
The importance of multi-domain interventions to address a range of risk factors which may contribute to mild cognitive impairment is also covered in the submission, with the college raising concerns around implementation under current ‘limited’ funding and equitable access to appropriately trained practitioners and no MBS-funded pathways to support these interventions.
‘These interventions often require ongoing support to be effective, which requires substantial resources that are not currently available,’ the submission states.
‘Investment in accessible, well-resourced support services with adequate funding will support primary care practitioners in recommending these interventions.’
To support the update of national dementia guidance, the RACGP has several existing clinical resources:
The college is also calling for creation of a living guideline to support usability, timely updates and ongoing relevance ‘as evidence in dementia care continues to evolve rapidly’, enabling the guidelines to respond to any important developments before the next formal review.
All submissions are now being considered by the Monash Guideline Development Group, which comprises national experts including people with lived experience of dementia, clinicians including GPs, researchers, and organisations involved in dementia support.
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clinical guidelines dementia dementia management dementia risk reduction preventive care RACGP submission
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