Resource utilization in dementia : a question of collaboration

Sammanfattning: This doctoral thesis investigates one disease management program in dementia located in Kalmar, Sweden with regard to the resource utilization. Dementia is a devastating disease which mainly affects the elderly. As the disease progresses the need for support increases. Dementia is one of the most costly diseases in our society. Although our understanding of dementia has advanced we have yet to discover a cure for the disease. Nevertheless with our current knowledge we can accomplish a great deal. The challenge is to incorporate this knowledge in order to provide high quality care for the patients and the caregivers without creating an economic burden for the society. It is therefore of interest to evaluate this dementia management program which supports the patient and caregiver from diagnosis to death. In Study I, the dementia management program in Kalmar was assessed. The program defined most of the expected new patients per year. And it was introduced within the existing budget, after reallocation of resources In Study II, examined costs of dementia diagnose assessment. Further was the true cost per diagnosed patient. Identified for primary care and specialist level. The study found that the cost of diagnosing dementia is small compared to the total budget required to care for persons with dementia, estimated to be approximately 1% of the total yearly cost of dementia in Sweden. In Study III, the use of selective psychotropic drugs in the elderly in Kalmar was compared with Swedish national data. The study found that after the introduction of the dementia management program, the use of dementia drugs increased, and the use of neuroleptics decreased. Furthermore the use of sedatives and drugs with anticholinergic effects was lower in Kalmar as compared to the whole of Sweden. In Study IV, examined resource utilization in dementia management in the Kalmar municipality. The Älvsjö municipality and the whole of Sweden were used for comparisons. The results suggest that the cost of dementia care in the Kalmar municipality did not increase due to implementation of the dementia program. Furtherer suggest the cost for dementia to be from neutrally to lower for the municipality of Kalmar compare to the municipality s in all of Sweden. The results from this investigation of the dementia management program in Kalmar, suggest that most of the new cases of dementia were diagnosed, treated and followed up. The cost of the program fell within the existing budget and no extra funding was required.