Dementia management in France: health care and support services in the community

In France, a wide range of care and support services exist for community dwelling people with Alzheimer's disease (AD). These are coordinated by the general practitioner (GP). We investigated interventions that were ‘prescribed’ by French GPs and analysed their perceived barriers to arranging these. Thirty-nine percent of GPs responded to a postal survey, which was sent to 1105 physicians belonging to the Sentinel GP Research Network and to 524 GPs consulting in the Rhône-Alpes region of France. Fifty percent of patients were treated with acetyl-cholinesterase inhibitors and the following other support services were used: home help (63%), nursing care (48%) and physiotherapy (35%). Although GPs acknowledged carers' need for emotional support, only minimal levels of other interventions such as day care (12%) and psychotherapeutic interventions (12%) were prescribed. Reasons for under-use included non-availability and carers' reluctance to undergo psychotherapy. Lack of integrated community care services, insufficient information on services, lack of collaboration between health professionals and the frequent absence of a reliable carer were considered the most important barriers to the effective support of people with dementia in primary health care settings.