New dementia data shows proactive care planning is key

New data has shed a light on the importance of GPs offering continuity of care and proactive planning for their dementia patients, for hospitals, and the broader healthcare system.
 
On Friday, the Australian Institute of Health and Welfare (AIHW) released an updated tranche of dementia-specific data, finding that in 2023 there were 411,100 Australians living with the disease.
 
However, the true reach of the condition remains unclear with ‘no single authoritative data source for deriving dementia prevalence in Australia’, according to the AIHW.
 
The data reveals that in 2022–23, there were 26,300 hospitalisations due to dementia in Australia, around two out of every 1000.
 
The average length of stay was 15.5 days, which is almost six times higher than the average length of stay for all hospitalisations.
 
According to the AIHW, a diagnosis of dementia will influence the cost of a hospitalisation even when it is not the main reason for being admitted to hospital.
 
It said the cost for a urinary tract infection hospitalisation was $6130 more for someone with dementia than someone without, it cost $4420 more for someone with both dementia and pneumonia, and $4856 more for a fractured femur.
 
Among people who were living in the community, 51% of people with dementia had a GP chronic disease management (CDM) attendance compared with 24% of people without dementia.
 
Dr Stephanie Daly, a GP with a special interest in dementia, told newsGP the data emphasised the importance of continuity of care and regular, scheduled consults for dementia patients.
 
‘People living with dementia have increased care needs, so they often have other complex comorbidities that require them to see a medical professional, and it’s often harder for them to manage those other comorbidities because of their dementia,’ she said.
 
‘That’s why they end up coming to see the GP more often, and what this data highlights is that the number of people actually with a CDM plan is quite low, and what would be better would be more proactive care.
 
‘Having everybody on a GP management plan coming in for regular reviews every few months, at least three to six months so that you can be more proactive about spotting those problems.’
 
In 2022–23, almost 688,000 prescriptions were dispensed for dementia-specific medications to 72,400 Australians, equivalent to 9.5 scripts per person, and of those, 57% were for women.
 
This equalled a 24% increase in the rate of scripts dispensed in the past decade.
 
In 2022–23, around 18,700 people were dispensed scripts for the first time, a 34% increase in 10 years, and GPs prescribed 50% of initial scripts, and 85% of continuing scripts.
 
Donepezil was the most commonly dispensed dementia-specific medication in 2022–23, accounting for almost 453,000 prescriptions, or 66%, of all scripts, followed by rivastigmine.
 
The rates of scripts being dispensed were lowest in the Northern Territory and highest in Tasmania.
 
However, the AHIW noted that drugs distributed by the Government’s Remote Area Aboriginal Health Services program are not included in PBS data and could account for the NT’s low prescribing rates.
 
Dr Daly said, overall, there were issues with the report’s data collection and the accuracy of that data, saying there is a need for better records of the people living with dementia.
 
‘We need to actually record that more accurately in our data set, because that’s helpful for when they draw out some of this data for programs, but they’re only as good as the records that we’re keeping,’ she said.
 
‘Having an accurate diagnosis means that when someone goes to hospital, there’s better planning for that person when they’re in hospital, so they have a reduced length of stay, hopefully, because the hospital is aware that they have a diagnosis.’
 
The AIHW itself admitted that ‘current and robust data on dementia-specific GP and community-based specialist services are a major data gap in Australia’.
 
With an ageing and growing population, it is predicted that dementia diagnoses will more than double by 2058 to 849,300.
 
With these alarming numbers in mind, Dr Daly’s advice to GPs moving forward is to book regular appointments with their patients living with dementia.
 
‘If they’re not seeing the same GP, it at least needs to be within the same practice ideally with one or two GPs,’ she said.
 
‘If we have lots of different people going to lots of different practices then things can get missed, things like medications or just issues with their other care needs.
 
‘If we just were a bit more proactive with our care planning, and documenting that, and our advanced care directives, and signposting to families about what they should be looking out for, then probably we’d reduce some of the impact of that on the health system.’
 
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