How do people with dementia utilise primary care physicians and specialists within dementia networks? Results of the Dementia Networks in Germany (DemNet-D) study

Abstract

Outpatient dementia healthcare is predominantly fragmented, and dementia networks (DNs) represent an integrated care concept to overcome this problem. Little is known about the patients of these networks with regard to utilisation of physicians and associated factors. We interviewed 560 caregivers of people with dementia in 13 different DNs in Germany in 2013 and assessed socio-demographics, clinical data and physician utilisation. Networks were categorised in predominantly medical DNs and community-oriented DNs. Descriptive and multivariate statistical models were used to identify associated factors between DNs and users' data. Overall, the users of networks received high rates of physician care; 93% of the sample stated at least one contact with a primary care physician within the last 6 months, and 74% had been treated by a specialist (neurology/psychiatry physician). Only 5% of the sample had no contact with a physician in the 6 months preceding the interview. Females showed a lower odds for physician specialist consultations (OR = 0.641). Users of medical DNs receive greater specialist consultations overall (OR = 8.370). Compared to the German general population and people with dementia in other settings, users of DNs receive physician care more regularly, especially with regard to the consultations of neurologist/psychiatrists. Therefore, DNs seem to perform a supportive role within the integration of physician healthcare. More research is needed on the appropriate relationship between the needs of the people with dementia and utilisation behaviour.

Care of community-dwelling older adults with dementia and their caregivers

“…Individuals with dementia can be identified either through population-level screening or through targeted case finding; however, expert opinion does not support screening and instead favours case finding in primary care settings. 9,10 Clinically, this means that evaluation for dementia should be started when there is a high probability of dementia based on the presence of risk factors (e.g., increased cardiovascular risk, or history of neurologic disorders such as stroke or Parkinson disease) 43 or when patients or caregivers raise concerns about cognition or functioning. 5 Identifying dementia using case-finding approaches may result in reduced numbers of false-positives when compared with screening of asymp-tomatic populations, according to a meta-analysis of cognitive tests.…”

Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management [intersec-CM]: study protocol for a randomised controlled trial

“…The short version ZBI is a caregiver self-report measure to examine burden that is associated with functional/behavioral impairments in the social, psychological and physiological context and home care situation. Scores range from 0(no burden) to 28 (highest possible burden) Data assessment tools for these dimensions will be chosen based on either their recommendation by the JPND expert group or common use in larger German trials such as IDEMUCK (39), DelpHi-MV (23,40,41), DemNet-D (42)(43)(44)(45) or IDA (46). These instruments are validated, and this will guarantee valid results and comparability in German and international studies.…”

Menschen mit Demenz in der primärärztlichen Versorgung

“…50.000 € scheint nach diesen Untersuchungen zum nachhaltigen Betrieb eines Demenznetzwerks notwendig [37]. Die längsschnittlichen Auswertungen der Probandendaten dauern noch an; Querschnittsanalysen weisen jedoch darauf hin, dass die Versorgung der von den Demenznetzwerken betreuten Menschen besser ist als in der Allgemeinbevölkerung [38][39][40]. Neben dem Nutzen der zu erwartenden Ergebnisse aus den weiteren Analysen hat diese Studie jedoch bereits zu einer nachhaltigen Veränderung des Versorgungssystems geführt.…”