Strategies Needed to Improve Delivery of Alzheimer Disease-Modifying Therapies

Models that enable primary care practitioners to diagnose and evaluate patients for treatment eligibility would have biggest impact on wait times

By Elana Gotkine HealthDay Reporter

TUESDAY, Jan. 30, 2024 (HealthDay News) — Strategies are needed to improve the delivery of Alzheimer disease (AD) disease-modifying therapies (DMTs), according to a report published online Jan. 30 by the RAND Corporation.

Jodi L. Liu, Ph.D., from the RAND Corporation in Santa Monica, California, and colleagues used a simulation model to examine how primary care capacity for early detection impacts the delivery of AD DMTs, taking into account geographic variation in patient populations and health system capacities.

The researchers note that across the United States, there is considerable variation in health care system capacity to detect, diagnose, and treat early-stage AD with DMTs. Estimated wait times and the number of patients treated are sensitive to the uptake of brief cognitive assessments. There was variation observed by state in the estimated average wait times, and these wait times could be three times longer in rural versus urban areas. According to the researchers, the biggest impact on reducing wait times for specialists would be with implementation of care models that enable primary care practitioners to diagnose and evaluate patients for treatment eligibility; this implementation would also have the largest impact on increasing the number of people treated from 2025 through 2044. Caseloads for specialists could be further reduced by improved triage of patients using blood-based biomarker tests. A combination of strategies to communicate the value of detection and treatment of patients, integrate primary care practitioners into the detection and diagnosis pathway, and address capacity disparities are required for widespread delivery of AD DMTs.

“Our analysis suggests that strategies are needed to ease the demand on specialists for evaluation and diagnosis of cognitive impairment,” Liu said in a statement.