Resource Utilization in Dementia a Question of Collaboration

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

Plasma concentration of galantamine - influence of dose and body mass index in Alzheimer’s disease.

Background/objectives: Patients with Alzheimer’s disease (AD) are at present treated with galantamine without actual knowledge of plasma concentration levels. The aim of this presentation is to analyse the relationship between galantamine plasma concentration, dose, demographics and body mass index (BMI). Methods: A total of 84 AD patients recruited at the Memory Clinic in Malmö, Sweden, treated with galantamine were included in this study. The patients were investigated at baseline, at 2 months and every 6 months for a period of three years. Blood samples were obtained at 180 of these investigations for the analysis of plasma galantamine concentration. Efficacy measures including cognitive tests (MMSE), functional ratings (IADL) and BMI were simultaneously evaluated. The dose as well as the time from drug intake to plasma extraction was investigated. Results: The mean galantamine plasma concentration demonstrated a strong positive linear association with dose (r=0.51, p<0.001). Moreover, patients with separate doses of galantamine (8, 16 and 24 mg daily) differed significantly in plasma concentration (p<0.001). No gender differences regarding dose were observed. There was no linear relationship between galantamine plasma concentration and BMI in the entire cohort. When investigating the impact of gender, a negative linear association (r=-0.45, p=0.001) between concentration and BMI was found in the male group but not in the female. Age did not influence the plasma concentration level. In a multivariate general linear model with concentration as the dependent variable, gender (p=0.010) and BMI (p=0.038) but not age (p=0.540) were predictive factors. Conclusion: Galantamine plasma concentration demonstrated a strong relationship with dose. The dose did not differ between genders, whereas the impact of body mass index on plasma concentration was important only among the males

Comparing estimated cost per patient for dementia care: Two municipalities and Swedish national population data

Abstract Aim: To evaluate a collaborative dementia program for its influence on cost and in which dementia care specialists and primary care centres collaborate with the municipality and, thereby, effect direct cost of dementia care. Methods: The cost of illness (COI) study investigated the cost of dementia care to the municipality, specifically on the Municipality of Kalmar. Municipal costs in the Municipality of Älvsjö and national cost figures for Sweden were used as comparisons. The major costs related to dementia care, such as the cost of home care, day-care centers, and nursing home placement were extracted from municipality records. Results: The yearly municipal cost per person with dementia in Kalmar ranged from 14,206 C to 26,334 C (17,684 USD to 32,780 USD) as compared to Älvsjö 10,610 C to 30,464 C (13,207 USD to 37,921 USD), and Swedish national figures showing costs from 23,600 C to 36,459 C (29,378 USD to 45,384 USD), per patient, annual cost. In Kalmar, 60% of the patients with dementia received help from the municipality as compared to 69% in Älvsjö. Conclusions: Implementation of such a dementia program is a recommendation that would not increase the cost for dementia care in the Municipality of Kalmar

Outcome of a psychosocial health promotion intervention aimed at improving physical health and reducing alcohol use in patients with schizophrenia and psychotic disorders (MINT)

Background: Life expectancy is reduced by 19 years in men and 17 in women with psychosis in Sweden, largely due to cardiovascular disease. Aim: Assess whether a psychosocial health promotion intervention improves cardiometabolic risk factors, quality of life, and severity of illness in patients with psychotic disorders more than treatment as usual. Methods: A pragmatic intervention trial testing a manual-based multi-component health promotion intervention targeting patients with psychosis. The Swedish intervention was adapted from IMPaCT therapy, a health-promotion program based on motivational interviewing and cognitive behavioral therapy, designed to be incorporated into routine care. The intervention group consisted of 119 patients and a control group of 570 patients from specialized psychosis departments. Outcome variables were assessed 6 months before intervention during the run-in period, again at the start of intervention, and 12 months after the intervention began. The control group received treatment as usual. Results: The intervention had no significant effect on any of the outcome variables. However, BMI, waist circumference, systolic BP, heart rate, HbA1c, general health, and Clinical Global Impressions Scale score improved significantly during the run-in period before the start of the active intervention (observer effect). The multi-component design meant that treatment effects could only be calculated for the intervention as a whole. Conclusion: The results of the intervention are similar to those of the U.K. IMPaCT study, in which the modular health-promotion intervention had little effect on cardiovascular risk indicators. However, in the current study, the run-in period had a positive effect on cardiometabolic risk factors

A symptom self-rating scale for schizophrenia (4s) : psychometric properties, reliability and validity

The objective of the study was to validate a self-administrated symptom rating scale for use in patients with schizophrenia spectrum disorders by item analysis, exploration of factor structure, and analyses of reliability and validity. Data on 151 patients, initially treated by risperidone, obtained within the framework of a naturalistic Phase IV longitudinal study, were analysed by comparing patient and clinician ratings of symptoms, side-effects and global indices of illness. The Symptom Self-rating Scale for Schizophrenia (4S) is psychometrically adequate (item analysis, internal consistency, factor structure). Side-effect ratings were reliable. Symptom ratings displayed consistent associations with clinicians' ratings of corresponding symptom dimensions, suggesting construct validity. Patients had most difficulties assessing negative symptom items. Patients were well able to assess their own symptoms and drug side-effects. The factor structure of symptom ratings differs between patients and clinicians as well as how they construe global indices of illness. Clinicians focus on psychotic, patients on affective symptoms. Use of symptom self-ratings is one way to improve communication and thereby strengthen the therapeutic alliance and increase treatment adherence

Dose and plasma concentration of galantamine in Alzheimer's disease - clinical application

Introduction: Patients with Alzheimer's disease (AD) are currently treated with cholinesterase inhibitors, such as galantamine, without actual knowledge of its concentration in plasma. Our objective was to analyse potential relationships between galantamine concentration, galantamine dose, socio-demographic characteristics, body weight, body mass index (BMI), and treatment response. Methods: Eighty-four patients with AD recruited from the Memory Clinic, Malmo, Sweden, and treated with galantamine were included in the study. Efficacy measures, including cognition (Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale - cognitive subscale (ADAS-cog)) and instrumental activities of daily living (IADL), were evaluated at baseline, 2 months after treatment initiation (MMSE only) and semi-annually over 3 years. At these assessments, blood samples were obtained for the analysis of the galantamine concentration, and body weight, BMI, drug dose and time from drug intake were recorded. Results: All patients had a measurable concentration of galantamine at all assessments. The mean plasma concentration of the drug exhibited a positive linear association with dose (r = 0.513, P < 0.001). The dose did not differ between sexes. Negative linear associations between the galantamine plasma concentration and BMI (r = -0.454, P = 0.001) or body weight (r = -0.310, P = 0.034) were found exclusively in the male group. When mixed-effects models were used, the dose of galantamine (P < 0.001), time from drug intake (P < 0.001), and BMI (P = 0.021) or weight (P = 0.002) were factors that predicted the concentration, whereas sex, age, and cognitive and functional changes were not. Conclusions: High compliance to galantamine treatment was found among all patients in this naturalistic AD study. The impact of BMI or body weight on the plasma concentration of galantamine was important only among males. No relationship was observed between concentration and short-term treatment response or progression rate in terms of cognitive and functional abilities

Resource utilization in mental illness–evaluation of an instrument for measuring direct costs of treatment for patients with severe mental illness (SMI)

Purpose: Serious mental illnesses (SMIs) exert a considerable financial burden on health-care systems. In this study, the resource utilization in mental illness (RUMI) tool was developed and employed to evaluate resource utilization in patients with SMI. Materials and methods: Data from 107 patients with SMI treated in four psychiatric outpatient clinics in Sweden were collected. The relationships between costs for physical and psychiatric care, social services, and the justice system, to self-reported health and quality of life, educational level, Global Assessment of Functioning (GAF), the Clinical Global Impressions scale score (CGI), and body mass index (BMI) were studied. Results: Sixteen out of 107 patients accounted for 74% of the total costs. The mean and median cost for 6 months included in the survey for social services, family and social welfare and healthcare, psychiatric and physical treatment interventions, mean 8349 EUR, median 2599 EUR per patient (currency value for 2021). Education and psychosocial function (GAF) were both negatively correlated with costs for the social services (education, r=–0.207, p < 0.014; GAF, r=–0.258, p < 0.001). CGI was correlated with costs for physical and psychiatric healthcare (r = 0.161, p < 0.027), social services support (r = 0.245, p = 0.002) and total cost (r = 0.198, p = 0.007). BMI correlated with costs for psychiatric and physical health settings interventions (r = 0.155, p < 0.019) and for somatic and psychiatric medicines (r = 0.154, p < 0.019). Conclusion: The RUMI scale was acceptable and enabled estimation of resource utilization in a comparable manner across different care settings. Such comparable data have potential to provide a basis for budgeting and resource allocation