Diagnosing and treating dementia in German primary and specialized care between 2011 and 2015

Int J Clin Pharmacol Ther. 2018 Jul;56(7):301-309. doi: 10.5414/CP203210.

Abstract

Background: Whilst there was no upturn in detection rate of persons with dementia (PwD) in German general practitioner (GP) practices before 2012, dementia diagnoses markedly increased in 2013 and 2014.

Objective: (1) Verify the increase of dementia diagnoses in GP practices and neurologist/psychiatrist (NP) practices; (2) examine the subsequent prescription of antidementia drugs.

Materials and methods: We performed a retrospective, longitudinal analysis of 874 GP and 141 NP practices collecting clinical data about 220,213 patients who received a dementia diagnosis (ICD-10: G30, F01, F03) between 2011 and 2015.

Results: In GP practices, documented dementia diagnoses increased by 73% between 2012 and 2014 (mean 6.4 - 11.1 PwD/practice) and decreased by 26% in 2015 (8.3 PwD/practice). This trend was mostly due to the subgroup of nonspecific (+63%) and vascular dementia (+170%). The upturn has been accompanied by a downturn of the proportion of PwD receiving antidementia drugs (2012: 13.9% vs. 2014: 7.8%). Neither of these trends was found in NP practices.

Conclusion: The upturn parallels the introduction of monetary incentives for both patients and GPs. It should be examined if these monetary incentives will also lead to an improvement in treatment and care of PwD in the long run. .

MeSH terms

  • Aged
  • Aged, 80 and over
  • Dementia / diagnosis*
  • Dementia / drug therapy*
  • Dementia / economics
  • Dementia / psychology
  • Drug Costs
  • Drug Prescriptions
  • Female
  • Germany
  • Health Services for the Aged* / economics
  • Health Services for the Aged* / trends
  • Humans
  • Longitudinal Studies
  • Male
  • Neurology* / economics
  • Neurology* / trends
  • Nootropic Agents / adverse effects
  • Nootropic Agents / economics
  • Nootropic Agents / therapeutic use*
  • Physician Incentive Plans
  • Practice Patterns, Physicians'* / economics
  • Practice Patterns, Physicians'* / trends
  • Primary Health Care* / economics
  • Primary Health Care* / trends
  • Psychiatry* / economics
  • Psychiatry* / trends
  • Referral and Consultation
  • Retrospective Studies
  • Specialization* / economics
  • Specialization* / trends
  • Time Factors
  • Treatment Outcome

Substances

  • Nootropic Agents