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Closing the dementia care gap: Can referral to Alzheimer's Association chapters help?

ABSTRACT: The quality of care provided by primary-care physicians for patients with dementia remains poor, in part because physicians do not provide counseling and education. Local Alzheimer's Association chapters have the potential to improve the quality of care provided for dementia, but are hampered by a lack of referrals from primary-care physicians. Many physicians remain unaware of the services available through Alzheimer's Association chapters, but recognize the need to provide support to families, ensure patient safety, and manage behavioral problems. At present, systems to promote referrals and communication with local chapters are lacking. Practice redesign may facilitate linkages between practices and Alzheimer's Association chapters. However, if these linkages are to be adopted and sustained, they must demonstrate a relative advantage to physicians beyond the care they currently provide, and must be compatible with how care is currently delivered in their practices.

SUBMITTER: Reuben D

PROVIDER: S-EPMC3688281 | biostudies-other | 2009 Nov

REPOSITORIES: biostudies-other

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Closing the dementia care gap: Can referral to Alzheimer's Association chapters help?

Reuben David D Levin Jennifer J Frank Janet J Hirsch Susan S McCreath Heather H Roth Carol C Wenger Neil N

Alzheimer's & dementia : the journal of the Alzheimer's Association 20091101 6

The quality of care provided by primary-care physicians for patients with dementia remains poor, in part because physicians do not provide counseling and education. Local Alzheimer's Association chapters have the potential to improve the quality of care provided for dementia, but are hampered by a lack of referrals from primary-care physicians. Many physicians remain unaware of the services available through Alzheimer's Association chapters, but recognize the need to provide support to families, ...[more]

PMID: 19896589

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Project description:Background The rising economic burden of cancer on patients is an important determinant of access to treatment initiation and adherence in India. Several publicly financed health insurance (PFHI) schemes have been launched in India, with treatment for cancer as an explicit inclusion in the health benefit packages (HBPs). Although, financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and determinants among the Indian population. There is a need to determine the optimal strategy for clinicians and cancer care centers to address the issue of high costs of care in order to minimize the financial toxicity, promote access to high value care and reduce health disparities. Methods A total of 12,148 cancer patients were recruited at seven purposively selected cancer centres in India, to assess the out-of-pocket expenditure (OOPE) and financial toxicity among cancer patients. Mean OOPE incurred for outpatient treatment and hospitalization, was estimated by cancer site, stage, type of treatment and socio-demographic characteristics. Economic impact of cancer care on household financial risk protection was assessed using standard indicators of catastrophic health expenditures (CHE) and impoverishment, along with the determinants using logistic regression. Results Mean direct OOPE per outpatient consultation and per episode of hospitalization was estimated as ₹8,053 (US$ 101) and ₹39,085 (US$ 492) respectively. Per patient annual direct OOPE incurred on cancer treatment was estimated as ₹331,177 (US$ 4,171). Diagnostics (36.4%) and medicines (45%) are major contributors of OOPE for outpatient treatment and hospitalization, respectively. The overall prevalence of CHE and impoverishment was higher among patients seeking outpatient treatment (80.4% and 67%, respectively) than hospitalization (29.8% and 17.2%, respectively). The odds of incurring CHE was 7.4 times higher among poorer patients [Adjusted Odds Ratio (AOR): 7.414] than richest. Enrolment in PM-JAY (CHE AOR = 0.426, and impoverishment AOR = 0.395) or a state sponsored scheme (CHE AOR = 0.304 and impoverishment AOR = 0.371) resulted in a significant reduction in CHE and impoverishment for an episode of hospitalization. The prevalence of CHE and impoverishment was significantly higher with hospitalization in private hospitals and longer duration of hospital stay (p < 0.001). The extent of CHE and impoverishment due to direct costs incurred on outpatient treatment increased from 83% to 99.7% and, 63.9% to 97.1% after considering both direct and indirect costs borne by the patient and caregivers, respectively. In case of hospitalization, the extent of CHE increased from 23.6% (direct cost) to 59.4% (direct+ indirect costs) and impoverishment increased from 14.1% (direct cost) to 27% due to both direct and indirect cost of cancer treatment. Conclusion There is high economic burden on patients and their families due to cancer treatment. The increase in population and cancer services coverage of PFHI schemes, creating prepayment mechanisms like E-RUPI for outpatient diagnostic and staging services, and strengthening public hospitals can potentially reduce the financial burden among cancer patients in India. The disaggregated OOPE estimates could be useful input for future health technology analyses to determine cost-effective treatment strategies.

Project description:BackgroundPostfracture care is suboptimal, and strategies to address this major gap in care are necessary. We investigated whether notifications sent by mail to physicians and patients would lead to improved postfracture care.MethodsWe conducted a randomized controlled trial (ClinicalTrials.gov identifier NCT00594789) in the province of Manitoba, Canada, from June 2008 to May 2010. Using medical claims data, we identified 4264 men and women age 50 years or older who recently reported major fractures, and who had not undergone recent bone mineral density testing or treatment for osteoporosis. Participants were randomized to three groups: group 1 received usual care (n = 1480), patients in group 2 had mailed notification of the fracture sent to their primary care physicians (n = 1363), and group 3 had notifications sent to both physicians and patients (n = 1421). Bone mineral density testing and the start of pharmacologic treatment for osteoporosis within the following 12 months were documented.ResultsAmong participants in group 1 (usual care), 15.8% of women and 7.6% of men underwent testing for bone mineral density or started pharmacologic treatment for osteoporosis. Outcome measures improved among participants in group 2 (30.3% of women and 19.0% of men, both p < 0.001) and group 3 (34.0% of women and 19.8% of men, both p < 0.001). No additional benefit was seen with patient notification in addition to physician notification. Combining groups 2 and 3, the absolute increase for the combined end point of bone mineral density testing or pharmacologic treatment was 14.9% (16.4% among women, 11.8% among men). The number needed to notify to change patient care was 7 (6 for women, 6 for men). The adjusted odds ratio (OR) to change patient care in group 2 was 2.45 (95% confidence interval [CI] 2.01-2.98); for group 3 the OR was 2.82 (95% CI 2.33-3.43).InterpretationThis notification system provides a relatively simple way to enhance post-fracture care.

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Closing the dementia care gap: Can referral to Alzheimer's Association chapters help?

Publications

Closing the dementia care gap: Can referral to Alzheimer's Association chapters help?

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