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How Breaking Down Care Bottlenecks Could Improve Dementia Treatment 

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

By getting primary care physicians to diagnose and evaluate patients for dementia-related treatment could make the greatest impact on cutting specialist visit wait times and boost the number of those treated between the years 2025 and 2044, the report from RAND, a nonprofit research organization.

Although primary care providers are able to give cognitive assessments, most forgo them due to the time it takes, the report notes. But giving physicians more training, boosting reimbursement rates and drafting new guidelines could improve the pace at which doctors diagnose and treat dementia-related conditions.

The report recommends that caseloads on cognitive disease specialists could be reduced through improved triage of biomarker tests that are common in identifying dementia.

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

Dementia diagnosis times were longest in Alaska, Arkansas, Idaho, Mississippi, Montana, Nevada, Oklahoma and Wyoming. Researchers noted that was due to the scarcity of dementia specialists in relation to the number of those 50 or older in those states, and that wait times in rural areas could be up to three times longer compared to cities.

In recent years, two disease-modifying Alzheimer’s drugs have been approved by the U.S. Food and Drug Administration (FDA) with more therapies in “late-stage clinical trials,” the report states, amid questions regarding price, availability and whether the treatments are covered by insurance.

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Researchers relied on simulations to gauge future patient demand and provider supply across the country which is the result of prior RAND research that looked at the readiness of the U.S. health care system before Alzheimer’s therapies were issued to patients as treatment, the release stated.

“Our estimates are not meant 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 health care system,” Liu said.

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

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

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