title: Specialist involvement and referral patterns in ambulatory medical care for patients with dementia in Germany: results of a claims data based case-control study.
abstract: BACKGROUND
  To analyze the referral processes from general practitioners to specialists and among specialists for dementia patients in the time periods before, during and after the diagnosis in Germany.
  
  
  METHODS
  In this case-control study claims data from 1,848 insurants with incident dementia aged 65 years and more and 7,392 matched controls were compared over a two-year period covering the pre-incidence, incidence and post-incidence time periods.
  
  
  RESULTS
  We found an increase in referrals of 30% in the incidence quarter, mainly from general practice to neuropsychiatry and from there to radiology. Referrals to clinical chemistry and other disciplines for dementia-specific reasons were negligible in amount. 34% of incident cases had at least one contact with a neuropsychiatrist during the year of incidence, and the majority of them visited this specialist repeatedly during that year. Only a minority (13.5%) of patients was referred to radiology for imaging. Referrals to other specialists declined whereas self-referrals did not increase.
  
  
  CONCLUSIONS
  The referral rates to relevant specialists (neuropsychiatry, radiology and clinical chemistry) are far less frequent than proposed in German guidelines. More research is needed to explain the gape between guidelines and daily care and to find ways for a better implementation of guidelines in ambulatory care. Guidelines should not only deal with diagnostic procedures and therapeutic options but also consider questions of applicability in daily clinical practice and propose effective organizational models of care provision.
authors.affiliation: Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany. bussche@uke.de
authors.forename: Hendrik
authors.initials: H
authors.lastname: van den Bussche
authors.forename: Birgitt
authors.initials: B
authors.lastname: Wiese
authors.forename: Daniela
authors.initials: D
authors.lastname: Koller
authors.forename: Marion
authors.initials: M
authors.lastname: Eisele
authors.forename: Hanna
authors.initials: H
authors.lastname: Kaduszkiewicz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.forename: Gerd
authors.initials: G
authors.lastname: Glaeske
authors.forename: Susanne
authors.initials: S
authors.lastname: Steinmann
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schön
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D016022:Case-Control Studies; D003704:Dementia / Q000628:therapy*; D005260:Female; D005858:Germany; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008511:Medicine; D012017:Referral and Consultation