BMJ  2006;333:1163 (2 December), doi:10.1136/bmj.333.7579.1163-a

Practice

Short cuts

Care management helps people live with dementia

People with dementia often need help from many different agencies. Their care can be complex, and—despite the best efforts of loved ones, primary care doctors, and specialists—many fall through the gaps in the system. Having a case manager to coordinate it all is one obvious solution, and it worked well in a randomised trial based in California. The case managers, usually social workers, trained carers and did assessments. They also recommended treatments and services and coordinated their delivery. Patients and carers both benefited from this fairly intensive intervention. Quality of care went up, and patients' quality of life deteriorated more slowly than that of control patients given usual care. Carers reported greater confidence and better social support.

There's now good evidence that these kind of interventions substantially improve the lot of patients with dementia and their carers, writes an editorial (pp 780-1). If they were drugs they would be fast tracked to approval. But the current reimbursement system in the US isn't designed for complex, intensive, multiagency treatments. So they are unlikely to be widely adopted until the system adapts, writes the author. Medicare, the federally funded insurance for people aged over 65, should start paying now for team based case management services.

References

Ann Intern Med 2006;145:713-26[Abstract/Full Text]

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