Dementia management programme in a community setting and the use of psychotropic drugs in the elderly population.

BACKGROUND AND OBJECTIVE: The number of elderly persons in society is increasing, placing additional demands on the public health system. Extensive use of drugs is common in the elderly, and in patients with dementia this further increases their vulnerability. Since 1998 the municipality of Kalmar, Sweden, has worked with a dementia management programme that focuses on early intervention in order to identify the patient's help needs at an early stage. An important part of the programme aims at optimizing pharmacological treatment. The objective of the present study is to evaluate whether the dementia programme had a secondary effect on the use of psychotropic medication in the elderly population in general. DESIGN AND SETTING: A retrospective, drug utilization study analysing the use of selected drug categories by the elderly (75 years and older) in the Kalmar municipality compared with the whole of Sweden. RESULTS AND CONCLUSIONS: The results suggest that the dementia programme contributed to an improvement in psychotropic drug use in the elderly as a secondary effect. Furthermore, the implementation of this programme did not require allocation of extra funding.

The cost of diagnosing dementia in a community setting.

OBJECTIVES: In order to cope with the increasing number of individuals with dementia, it is crucial to develop the diagnostic capacity in primary care in cooperation with dementia specialists. Further, in order to establish prerequisites for care and planning it is important to identify the cost of dementia diagnosis. This study aims to evaluate the cost of establishing a dementia diagnosis. METHODS: This is a prospective, time- and resource utilization study for the identification of the total cost associated with diagnosing dementia (from start of the diagnostic process to time for established or rejected dementia diagnosis) both at the specialist and primary care level. RESULTS: Dementia evaluation in primary care took between 2 weeks and 2 months before reaching diagnosis. The average cost for all patients evaluated at the primary care level was 477 Euro (euro), whereas evaluations done on a specialist level reached a cost of 1115 euro. Thus, the costs per true diagnosed case consist of the cost for all dementia investigations divided by the number of finalized diagnoses. CONCLUSIONS: In this study the cost for diagnosing dementia per true diagnosed patient is 849 euro at the primary care level and 1334 euro at the specialist level. Based on this result we estimated that the cost of establishing a dementia diagnosis is 1% of the total cost of dementia.

A Swedish programme for dementia diagnostics in primary healthcare.

OBJECTIVE: To meet diagnostic needs of dementia, a new care programme was implemented in the county of Kalmar, Sweden. The objective of the study was to analyse whether the programme could identify and diagnose the estimated number of new cases. METHODS: A long-term follow up study on all new patients referred to primary and specialist care between 1999 and 2005 for dementia evaluation. RESULTS; Based on epidemiological data, 153 new cases per year were expected. Using the programme, an average of 127 cases was identified in primary healthcare and 22 at specialist level. Although the number of false-negative cases is not known, it may be concluded that most of the new cases with dementia were identified. The proportion of cases identified doubled after implementing the programme. The programme was implemented within an unchanged budget. CONCLUSION: The programme may be of value for diagnosis and management of demented patients in primary healthcare.