Abstract

Objectives: Early detection and intervention of dementia requires a highly efficient triage system, in view of the limited specialist manpower resulting in inaccessible diagnostic service. Task-sharing/task-shifting between specialists and primary care professionals in the screening and diagnosis of non-complicated cases of Alzheimer’s disease may be a solution. Collaborative care between private healthcare providers and social care provided by non-governmental organisations, using government healthcare allowance, is also an area to be explored. . In Hong Kong, a pilot project led by the Hong Kong Alzheimer’s Disease Association is testing a model that involves an early detection service (EDS) provided by trained social workers and occupational therapists, who refer people with suspected dementia to specialist-trained primary care physicians (PCP) in private practice for diagnostic consultation, using a healthcare voucher provided by the government. We aim to evaluate the user and provider experience in this project.

Methods: This is a mixed-method study involving (1) a quasi-experimental study of carer-person with dementia dyads receiving EDS and PCP diagnosis with follow-up social care versus EDS only; and (2) a qualitative study with carers and PCPs to investigate their experience in the dementia early detection service. Baseline quantitative data from 102 dyads, and qualitative data from seven informal carers and five PCP interviews were available.

Results: Among the 102 dyads, 44% found the help-seeking process easy or very easy, with only 15% found it difficult in the help-seeking process. The mean waiting time from EDS to receiving a diagnosis from PCP was 45.6 days, compared with a waiting time ranging from 44 to 134 weeks in public hospital psychiatric outpatient clinics. Carers who had prior experience of long waiting time for diagnostic service expressed regrets of lost time and unhelpful referrals before getting in touch with EDS. Trained PCPs emphasized the necessity of support from social care to engage people with dementia, particularly families with lower socioeconomic status who may otherwise opt for no treatment against their advice. Apart from specialists support, PCPs also raised several key considerations to ensure a viable model, including sufficient value of the healthcare voucher for dementia consultations, support on medication costs, optimal dementia patient load tailored for individual clinic business model, and awareness/readiness of the public about the role of PCPs in private practice in dementia diagnosis and management.

Conclusions: Initial user and provider experience from the pilot project suggests that task-sharing involving PCPs is acceptable and feasible. Outcome data from this project will provide information about the effects of this faster path to diagnosis with PCP compared with traditional triage system.