Journal of General Internal Medicine

, Volume 22, Issue 11, pp 1487–1492 | Cite as

Practice Constraints, Behavioral Problems, and Dementia Care: Primary Care Physicians’ Perspectives

  • Ladson Hinton
  • Carol E. FranzEmail author
  • Geetha Reddy
  • Yvette Flores
  • Richard L. Kravitz
  • Judith C. Barker
Original Article



To examine how practice constraints contribute to barriers in the health care of persons with dementia and their families, particularly with respect to behavioral aspects of care.


Cross-sectional qualitative interview study of primary care physicians.


Physicians’ offices.


Forty primary care physicians in Northern California.


Open-ended interviews lasted 30–60 minutes and were structured by an interview guide covering clinician background and practice setting, clinical care of a particular patient, and general approach to managing patients with AD or dementia. Interviews were transcribed and themes reflecting constraints of practice were identified through a systematic coding process.


Recurring themes (i.e., those present in ≥25% of physician interviews) included insufficient time, difficulty in accessing and communicating with specialists, low reimbursement, poor connections with community social service agencies, and lack of interdisciplinary teams. Physician narratives suggest that these constraints may lead to delayed detection of behavior problems, “reactive” as opposed to proactive management of dementia, and increased reliance on pharmacological rather than psychosocial approaches.


Physicians often feel challenged in caring for dementia patients, particularly those who are more behaviorally complex, because of time and reimbursement constraints as well as other perceived barriers. Our results suggest that more effective educational interventions (for families and physicians) and broader structural changes are needed to better meet the needs of the elderly with dementia and their families now and in the future. Without these changes, dementia care is likely to continue to fall short.


dementia quality of care barriers qualitative 



Dr. Hinton received support from Grants K23AG19809, R01AG012975, P30AG010129, R03AG020343 from the National Institute on Aging and an intramural grant from the UC Davis Health System. Dr. Kravitz is supported by a Mid-Career Investigator Award (K24 MH7256) from the National Institute of Mental Health. Dr. Franz receives support from Grants R01AG018386, R01AG0223815, R01AG022982 from the National Institute on Aging.

Potential Financial Conflict of Interest

None to disclose.

Author contributions

Study concept and design: Drs. Hinton, Franz, Flores, and Kravitz. Acquisition of subjects and data: Drs Hinton, Franz, Flores, and Geetha Reddy. Analysis and interpretation of data: Drs. Hinton, Franz, Flores, Barker, Kravitz, and Geetha Reddy. Preparation of manuscript: Dr. Hinton with input and review of other authors.

Sponsors’ role

The funding agencies played no role in design of the study or preparation of this manuscript.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Ladson Hinton
    • 1
  • Carol E. Franz
    • 2
    Email author
  • Geetha Reddy
    • 3
  • Yvette Flores
    • 4
  • Richard L. Kravitz
    • 5
  • Judith C. Barker
    • 6
  1. 1.Department of Psychiatry and Behavioral Sciences and Alzheimer’s Disease CenterUC DavisSacramentoUSA
  2. 2.Department of PsychiatryUC San DiegoLa JollaUSA
  3. 3.School of MedicineUCLALos AngelesUSA
  4. 4.Chicana/o StudiesUC DavisDavisUSA
  5. 5.Department of Internal Medicine and Center for Healthcare Policy and ResearchUC DavisSacramentoUSA
  6. 6.Department of Anthropology, History, and Social MedicineUC San FranciscoSan FranciscoUSA

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