In:
Alzheimer's & Dementia, Wiley, Vol. 16, No. S10 ( 2020-12)
Abstract:
Prior research suggests that health systems are unprepared for a potential disease‐modifying treatment (DMT) for Alzheimer’s disease and projected substantial delays in access. We analyzed whether and to what degree changes to institutional arrangements (e.g., policies, incentives and regulations) could improve capacity and readiness in five countries. Method Desk research and expert interviews in France, Germany, Italy, Spain, and the U.K. focusing on planning for and coverage of memory services, ability of providers to adapt to a surge in demand and provider capabilities along the patient journey from diagnosis to treatment. Result No country has a government‐led plan to prepare for the advent of a DMT or advance planning to budget for the expected increase spending. Spain and the U.K. have expert‐led initiatives to inform the policy dialog. Screening for cognitive decline is not recommended or covered in any of the countries. While all cover initial evaluation of memory complaints in primary care settings, it is often not performed because of limited knowledge, lack of tools and fatalistic attitude. Patients with suspected cognitive decline have access to specialist memory services in all five countries, led by geriatric psychiatrists (Germany and U.K.) or neurologists (France, Italy and Spain). Scale and scope vary substantially within and across countries, with only France and the U.K. attempting to standardize services. Only Italy and Spain cover biomarker testing based on PET scans or CSF tests for routine care. Memory services operate at capacity in all countries with wait times of at least two months, and limited flexibility to scale up due to low numbers of dementia specialists, lack of budget and complex planning processes. Psychiatry‐led services tend to be less prepared for the medicalized requirements of a DMT delivery. Conclusion Institutional preparedness and funding for a DMT needs to be improved in all five countries, particularly by strengthening primary care with training and tools, such as simple cognitive tests and blood‐based tests for Alzheimer’s biomarkers, as workforce and budget constraints limit the ability to scale up specialist services. Such improvements would also improve access to and quality of memory care in the absence of a DMT.
Type of Medium:
Online Resource
ISSN:
1552-5260
,
1552-5279
Language:
English
Publisher:
Wiley
Publication Date:
2020
detail.hit.zdb_id:
2201940-6
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