Health Professionals' Perspectives on the Referral Process in Mild Cognitive Impairment: Facilitators, Barriers, and Solutions.

Introduction: Early detection and referral of patients with mild cognitive impairment or early-stage dementia can contribute to improved outcomes for both patients and caregivers. Few studies explore the quality and underlying context of referral decision-making by Primary Care Clinicians. This study aimed to explore the perspectives of healthcare professionals from Northern Portugal regarding the facilitators, barriers, and solutions within the referral process to the Neurology service for patients suspected of having mild cognitive impairment.

Methods: Two face-to-face focus groups were conducted with 11 primary and secondary care professionals from Northern Portugal, with experience in the field of dementia, selected and recruited through an email invitation. The discussion focused on the benefits of referrals, the strengths and challenges faced at different levels of care, and possible improvement strategies. Data were analyzed using inductive and deductive thematic analysis, with triangulation employed to ensure research rigor.

Results: The study identified facilitators and barriers at the levels of patients and caregivers, healthcare professionals, and the healthcare system. This process is influenced by interconnected factors, including the sociodemographic and literacy context of patients and caregivers, clinical practice regarding the application of referral criteria, and the organizational and research context of the local healthcare system concerning dementia. Solutions were proposed to overcome the highlighted barriers, whose implementation is supported by many of the facilitators described.

Conclusion: A deeper understanding of the interplay between sociodemographic, clinical, and organizational factors can lead to more objective and effective referral decisions, ultimately supporting timely diagnosis and enhancing quality of life. The findings of this study are valuable for optimizing local referral processes and may be useful in similar healthcare contexts. It is recommended that future research include the perspectives of patients and caregivers to enhance the approach to the national dementia strategy.