title: Current implications for the managed care of dementia.
abstract: Medicare Part D changes are becoming an increasingly complex issue, presenting a challenge to many physicians treating dementia patients. A 2006 American Medical Directors Association survey found that 70% of its members reported difficulty with the Medicare prescription drug plan, with 28% of all physicians having difficulty in accessing dementia medications. Concerns about medication access are worrisome, particularly in light of data demonstrating their positive effects on behavioral symptoms, which may result in reduced use of psychotropic medications. Strategies for improving access to antidementia medications in nursing homes and assisted living facilities are highlighted, including an overview of appropriate use of antidementia medications (cholinesterase inhibitors and glutamate pathway modifiers), use of nonpharmacologic interventions, risk reduction in patients with dementia, accounting for resident preferences, and proper documentation. Finally, end-of-life issues in advanced dementia and defining quality of life are also addressed in a brief commentary. Recognition and understanding of these issues may improve patient access to medication, leading to improved patient healthcare outcomes and reduced dementia-related healthcare costs.
authors: Health Policy Institute, University of the Sciences in Philadelphia, 600 S 43rd St, Philadelphia, PA 19104, USA. r.stefan@usip.edu
authors: Richard G
authors: RG
authors: Stefanacci
mesh_terms: D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002800:Cholinesterase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D003657:Decision Making; D003704:Dementia / Q000188:drug therapy / Q000191:economics; D017850:Economics, Pharmaceutical; D017048:Health Care Costs; D006801:Humans; D054524:Medicare Part D / Q000191:economics*; D014481:United States
chemical_list: D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors