Differences in diagnostic process, treatment and social support for Alzheimer’s dementia between primary and specialist care: results from the Swedish Dementia Registry
An ageing population has led to an increasing prevalence of dementia disorders, putting pressure on health care systems to develop efficient strategies for diagnosis and care.
In many care systems, this has meant shifting some of the diagnostic burden onto primary care physicians.
The Swedish Dementia Registry, SveDem, is a nationwide quality registry founded in 2007 with a view to improving quality and equality of dementia care throughout the country. Patients are registered with SveDem at the time of dementia diagnosis, together with information on demographic background, living situation, cognitive level and medication.
The Swedish Board of Health and Welfare published guidelines in 2010 defining the requirements for a dementia diagnosis and giving recommendations on treatment and care. One of the aims of SveDem is to evaluate compliance with these guidelines.
Diagnosis of dementia in primary care is well established in Sweden. The aim of our study was to compare diagnostic process, treatment and access to social support between patients with Alzheimer’s dementia diagnosed in memory clinics (specialised care) and those diagnosed by primary care. We also wanted to check how primary and specialist care complied with the national guidelines.
We included in our study, 9,625 patients with Alzheimer’s dementia diagnosed between 2011 and 2014. Sixty per cent (5734) were from specialised care and forty per cent (3,891) from primary care. Patients diagnosed in primary care were on average older, and had lower cognitive level at the time of diagnosis. They were also more likely to receive home-care or day care and were diagnosed faster. Fewer diagnostic tests were performed in primary care and some tests were less likely to be performed. The greatest differences were found in neuro-imaging—usually computer tomography (CT) of the brain (83 per cent completed in primary care compared to 98 per cent in secondary care) and clock test (84 per cent in primary care versus 93 per cent in specialist care). After adjusting for background factors, prescription of antipsychotics was lower in primary care, while prescription cholinesterase inhibitors (specific dementia medication) did not differ between primary and specialist care.
We concluded from this study that the background characteristics of patients diagnosed in primary and specialist care are different, and this may lead to different testing required to reach a diagnosis. Primary care excelled in restriction of antipsychotics while the use of head CT and clock test are areas for improvement.
Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden