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How breaking care bottlenecks could improve dementia treatment

Primary care provider involvement could be key to increasing the pace and scope of treatment for early-stage Alzheimer’s disease, according to a new report.

Getting primary care doctors to diagnose and assess patients for dementia-related treatment could have the biggest impact on reducing waiting times for specialist visits and increasing the number of people seen between 2025 and 2044, according to the report by RAND, a non-profit research organization.

Although primary care providers are capable of performing cognitive assessments, most forgo them because of the time it takes, the report notes. But giving doctors more training, increasing reimbursement rates and writing new guidelines could improve the rate at which doctors diagnose and treat dementia-related conditions.

The report recommends that the caseload of cognitive disease specialists can be reduced by improving triage of biomarker tests that are common to identify dementia.

“System-level barriers may mean that people with early-stage Alzheimer’s will not benefit from therapies that could slow the progression of the disease,” Jodi Liu, lead author of the report and senior policy researcher at RAND. “Our analysis suggests that strategies are needed to ease the demand on specialists for the assessment and diagnosis of cognitive impairment.”

Dementia diagnosis times were longest in Alaska, Arkansas, Idaho, Mississippi, Montana, Nevada, Oklahoma and Wyoming. The researchers noted that this was due to a shortage of dementia specialists relative to the number of people aged 50 and over in these states, and that waiting times in rural areas could be as long as three times longer compared to cities.

In recent years, the US Food and Drug Administration (FDA) has approved two disease-modifying drugs with more therapies in “advanced-stage clinical trials”, the report says, amid questions about price, availability and if the treatments are covered by insurance.

The researchers relied on simulations to assess future patient demand and provider supply across the country, which is the result of previous RAND research that looked at the readiness of the U.S. health care system before the Alzheimer’s therapies were issued to patients as treatment, according to the statement.

“Our estimates are not intended to predict exactly what treatment delivery will look like, but to provide feasible scenarios that can help inform where bottlenecks may occur and identify areas where attention may be needed to prepare the healthcare system,” Liu said. .

But the researchers noted that more work is needed to determine how primary care efforts can manage treatment for early-stage Alzheimer’s disease, and provider reimbursement will have a “critical influence” on the pace at which providers administer treatments to patients.

“Widespread delivery of disease-modifying therapies for Alzheimer’s will require a combination of strategies to communicate the value of screening and treatment to patients, integrate primary care providers into the screening and diagnostic system, and address the geographic disparities in health system capacity around the world. nation,” Liu said.

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