- Email: [email protected]
An outpatient memory department in germany: Is this financially feasible?
Poster Presentations: P2
In a sub-analysis, patients screening positive in specialty care had a higher (29%) rate of emergency room visits, but no significant difference in hospitalizations. In contrast, patients screening positive in primary care had an 83% higher rate of incident hospitalizations but no significant difference in emergency room visits. Conclusions: Standardized cognitive screening in older adults has the potential to do more than promote earlier detection of dementia in health care settings. We show that cognitive impairment is associated with higher pre-screening acute care utilization; the next step is to examine the predictive value of screen-detected cognitive impairment on subsequent health care outcomes and utilization.
P2-254
PERCEPTIONS OF DEMENTIA PROGRAMS IN CUSCO, PERU: SWOT ANALYSIS
Madura Sundareswaran1, Mona Ahmad2, Raywat Deonandan2, University of Alberta, Edmonton, AB, Canada; 2University of Ottawa, Ottawa, ON, Canada. Contact e-mail: [email protected]
1
Background: As the worldwide incidence of dementia continues to
rise, its burden is over-represented by low-middle income countries (LMICs). Thus, low resource countries require substantial supports and services, as numerous barriers to accessing care are known to exist. Unlike those beset with physical impairments, persons with dementia in LMICs are less likely to use healthcare services despite availability, highlighting the importance of culturally appropriate interventions. Given the lack of literature on existing dementia programs in LMICs, and even less information on programs in specific regions, this study used SWOT (strengths, weaknesses, opportunities, and threats) analysis to understand healthcare workers’ perceptions of current dementia supports and services in Cusco, Peru. Methods: Healthcare workers completed questionnaires asking about each of the parameters of SWOT. A total of 74 questionnaires were collected. Responses were translated and thematic analysis conducted to identify healthcare workers’ perceptions of dementia programs in Cusco. Results: Preliminary results indicate wide variations in frontline workers’ understanding of dementia and its diagnosis and management. The availability and training of psychologists was frequently discussed as a strength and opportunity for improving local access to services. Insufficient “buy-in” from families due to factors such as stigma and knowledge gaps was found to be both a weakness and threat, along with financial barriers at the local and national level. Conclusions: While analysis of the bulk of the data is still underway, initial results suggest that expected broad themes of stigma and financing are largely dictating the pace of dementia support in Peru. The implication for policy directives is an increased focus on both cost efficiency and public education.
P2-255
AN OUTPATIENT MEMORY DEPARTMENT IN GERMANY: IS THIS FINANCIALLY FEASIBLE?
Klaus Hager, Magdalene Kenklies, Diakoniekrankenhaus Henriettenstiftung gGmbH, Hannover, Germany. Contact e-mail: klaus. [email protected] Background: The outpatient memory department of the Center for Medicine in the Elderly in Hannover was founded in 1995. After an extensive neuropsychological testing and a discussion of the results of the physician with the patient and its caregiver plus writing of a letter to the referring neurologist or general practitioner, at least 120 min per patient are necessary. Because of that large amount of
P589
time many think that such a structure cannot be financed by its revenues. Methods: The earnings in 2013 for patients who consulted the memory department were reviewed. Results: In 2013 403 regularly insured patients were seen, for whom 26,881.45 Euros were paid by their health insurances, which means 292.19 Euros on an average per patient. Compared to the time invested (one hour for the neuropsychologist, one hour for the physician) this was 146.10 Euros per hour. Conclusions: An income of 146.10 Euros per hour seems high but this does not take into account that additional time has to be invested in follow up calls with the patient, his caregiver or the treating physician or for reviewing the MRIs. Nonpersonnel costs have to be added too. Even if this is taken into account, an extensive testing and consultation should be possible with the money paid by the insurance. But 403 patients per year are not enough to employ staff that is solely responsible for this structure. The memory department in Hannover generates further revenues by referring patients to the clinic to which it belongs as well as by participating in international phase II-III studies. As a standalone structure an outpatient memory department therefore does not seem to be profitable, a memory department within an institution with further ways of financing itself however is feasible.
P2-256
CAREGIVER EXPERIENCE OF GRIEF AND BURDEN IS SIMILAR ACROSS ALZHEIMER’S, PARKINSON’S, AND LEWY BODY DEMENTIA TYPES
Taylor Rigby1, Robert Ashwill2, Stephanie Mulhall1, David Kevin Johnson2, James E. Galvin3, 1University of Kansas, Lawrence, KS, USA; 2Univeristy of Kansas, Lawrence, KS, USA; 3New York University, New York, NY, USA. Contact e-mail: [email protected] Background: Little is known about the differences in the experience of caregiving across different dementia types. Extant studies have focused primarily on caregivers of people with Alzheimer’s disease (AD); however, Dementia with Lewy Bodies (DLB) is the second most common form of dementia and the current state of the research overlooks potentially important differences. Because the symptom profiles of these dementias differ, caregivers of AD and DLB may also experience stress and burden differently. We previously described differences in dimensions of caregiver burden between DLB and AD, particularly worry about performance. Because of the overlapping symptom profiles of Parkinson disease with dementia (PDD) and DLB, we also included PDD caregivers as a comparison group. Methods: Caregivers (N ¼505) of individuals with DLB (n¼376), AD (n¼66), or PDD (n¼63) completed a series of self-report online surveys: Condensed Ryff Psychological Well-Being Scale (PWBS), Marwit Meuser Caregiver Grief Inventory (MMCGI), Patient Health Questionnaire – Caregiver Depression (PHQ2), Perceived Change Index – Caregiver Well-being (PCICG), Prolonged Grief Scale (PGS), Quality of Life – Dementia Caregivers (QOLCG), Revised Memory and Behavior Problems Checklist (RMBPC), and Zarit Burden Interview (ZBI). Results: Overall, caregivers for people with AD, DLB, and PDD were very similar profiles for health, grief, burden, and existential loss (all Fs 1.78, p>.05). Of the 9 caregiver measure outcomes only 2 subscales rose to the level of significance. Caregivers of individuals with DLB reported that their loved ones experienced depressive symptoms more often than did their AD F(1, 403)¼4.55, p¼0.034 counterparts. Second, caregivers for people with PDD reported more personal strain than did their DLB
In a sub-analysis, patients screening positive in specialty care had a higher (29%) rate of emergency room visits, but no significant difference in hospitalizations. In contrast, patients screening positive in primary care had an 83% higher rate of incident hospitalizations but no significant difference in emergency room visits. Conclusions: Standardized cognitive screening in older adults has the potential to do more than promote earlier detection of dementia in health care settings. We show that cognitive impairment is associated with higher pre-screening acute care utilization; the next step is to examine the predictive value of screen-detected cognitive impairment on subsequent health care outcomes and utilization.
P2-254
PERCEPTIONS OF DEMENTIA PROGRAMS IN CUSCO, PERU: SWOT ANALYSIS
Madura Sundareswaran1, Mona Ahmad2, Raywat Deonandan2, University of Alberta, Edmonton, AB, Canada; 2University of Ottawa, Ottawa, ON, Canada. Contact e-mail: [email protected]
1
Background: As the worldwide incidence of dementia continues to
rise, its burden is over-represented by low-middle income countries (LMICs). Thus, low resource countries require substantial supports and services, as numerous barriers to accessing care are known to exist. Unlike those beset with physical impairments, persons with dementia in LMICs are less likely to use healthcare services despite availability, highlighting the importance of culturally appropriate interventions. Given the lack of literature on existing dementia programs in LMICs, and even less information on programs in specific regions, this study used SWOT (strengths, weaknesses, opportunities, and threats) analysis to understand healthcare workers’ perceptions of current dementia supports and services in Cusco, Peru. Methods: Healthcare workers completed questionnaires asking about each of the parameters of SWOT. A total of 74 questionnaires were collected. Responses were translated and thematic analysis conducted to identify healthcare workers’ perceptions of dementia programs in Cusco. Results: Preliminary results indicate wide variations in frontline workers’ understanding of dementia and its diagnosis and management. The availability and training of psychologists was frequently discussed as a strength and opportunity for improving local access to services. Insufficient “buy-in” from families due to factors such as stigma and knowledge gaps was found to be both a weakness and threat, along with financial barriers at the local and national level. Conclusions: While analysis of the bulk of the data is still underway, initial results suggest that expected broad themes of stigma and financing are largely dictating the pace of dementia support in Peru. The implication for policy directives is an increased focus on both cost efficiency and public education.
P2-255
AN OUTPATIENT MEMORY DEPARTMENT IN GERMANY: IS THIS FINANCIALLY FEASIBLE?
Klaus Hager, Magdalene Kenklies, Diakoniekrankenhaus Henriettenstiftung gGmbH, Hannover, Germany. Contact e-mail: klaus. [email protected] Background: The outpatient memory department of the Center for Medicine in the Elderly in Hannover was founded in 1995. After an extensive neuropsychological testing and a discussion of the results of the physician with the patient and its caregiver plus writing of a letter to the referring neurologist or general practitioner, at least 120 min per patient are necessary. Because of that large amount of
P589
time many think that such a structure cannot be financed by its revenues. Methods: The earnings in 2013 for patients who consulted the memory department were reviewed. Results: In 2013 403 regularly insured patients were seen, for whom 26,881.45 Euros were paid by their health insurances, which means 292.19 Euros on an average per patient. Compared to the time invested (one hour for the neuropsychologist, one hour for the physician) this was 146.10 Euros per hour. Conclusions: An income of 146.10 Euros per hour seems high but this does not take into account that additional time has to be invested in follow up calls with the patient, his caregiver or the treating physician or for reviewing the MRIs. Nonpersonnel costs have to be added too. Even if this is taken into account, an extensive testing and consultation should be possible with the money paid by the insurance. But 403 patients per year are not enough to employ staff that is solely responsible for this structure. The memory department in Hannover generates further revenues by referring patients to the clinic to which it belongs as well as by participating in international phase II-III studies. As a standalone structure an outpatient memory department therefore does not seem to be profitable, a memory department within an institution with further ways of financing itself however is feasible.
P2-256
CAREGIVER EXPERIENCE OF GRIEF AND BURDEN IS SIMILAR ACROSS ALZHEIMER’S, PARKINSON’S, AND LEWY BODY DEMENTIA TYPES
Taylor Rigby1, Robert Ashwill2, Stephanie Mulhall1, David Kevin Johnson2, James E. Galvin3, 1University of Kansas, Lawrence, KS, USA; 2Univeristy of Kansas, Lawrence, KS, USA; 3New York University, New York, NY, USA. Contact e-mail: [email protected] Background: Little is known about the differences in the experience of caregiving across different dementia types. Extant studies have focused primarily on caregivers of people with Alzheimer’s disease (AD); however, Dementia with Lewy Bodies (DLB) is the second most common form of dementia and the current state of the research overlooks potentially important differences. Because the symptom profiles of these dementias differ, caregivers of AD and DLB may also experience stress and burden differently. We previously described differences in dimensions of caregiver burden between DLB and AD, particularly worry about performance. Because of the overlapping symptom profiles of Parkinson disease with dementia (PDD) and DLB, we also included PDD caregivers as a comparison group. Methods: Caregivers (N ¼505) of individuals with DLB (n¼376), AD (n¼66), or PDD (n¼63) completed a series of self-report online surveys: Condensed Ryff Psychological Well-Being Scale (PWBS), Marwit Meuser Caregiver Grief Inventory (MMCGI), Patient Health Questionnaire – Caregiver Depression (PHQ2), Perceived Change Index – Caregiver Well-being (PCICG), Prolonged Grief Scale (PGS), Quality of Life – Dementia Caregivers (QOLCG), Revised Memory and Behavior Problems Checklist (RMBPC), and Zarit Burden Interview (ZBI). Results: Overall, caregivers for people with AD, DLB, and PDD were very similar profiles for health, grief, burden, and existential loss (all Fs 1.78, p>.05). Of the 9 caregiver measure outcomes only 2 subscales rose to the level of significance. Caregivers of individuals with DLB reported that their loved ones experienced depressive symptoms more often than did their AD F(1, 403)¼4.55, p¼0.034 counterparts. Second, caregivers for people with PDD reported more personal strain than did their DLB