["No shows" in dementia diagnostics: qualitative perspectives of patients and caregivers after a positive case finding by general practitioners].

BACKGROUND: The timely diagnostics of cognitive impairments and dementia syndromes are central to geriatric care. Memory clinics typically perform differential diagnostics following positive case findings in the general practitioner's practice; however, care pathways do not function smoothly, as shown by the "iCreate" project. Of 95 patients with positive case findings only 68 utilized the referral to the memory clinic; 27 were no shows. While barriers before the first doctor's visit are well-researched, analysis of the transition between primary and specialist care settings is lacking. The aim was to understand why further differential diagnostics after positive case findings were not pursued and to derive recommendations for action.

METHOD: Qualitative design with semi-structured interviews (n = 9) and telephone surveys (n = 15) of 24 of the 27 no shows or relatives from "iCreate". Software-assisted evaluation using qualitative content analysis according to Kuckartz and Rädiker.

RESULTS: Affected individuals experience a care gap with uncertainties and an individual interplay of barriers on three levels: a) psychosocial: fear of loss of autonomy/stigma, denial/ambivalence, desire/right not to know; b) structural and organizational: transport/appointment/coordination problems and c) care-related and process-related: unclear benefits, lack of follow-up options.

CONCLUSION: Case finding programs require standardized communication pathways with written summaries (working diagnosis, next steps, contact persons). Stepwise shared decision-making supported by dementia care managers could reduce the perceived barriers and drop-outs while closing care gaps.