There is no mechanism in government to coordinate care specifically for people living with dementia. However, there is the National Policy for Primary Care (Política Nacional de Atenção Básica) that includes the Family Healthcare Strategy (a multidisciplinary team of health professionals that provides regular care to the community). These groups are the first point of contact between people in the community and the provision of public healthcare (Brazilian Ministry of Health, 2012). Based on a multidimensional assessment, people are referred to more specialized care where they can access diagnoses and treatments when needed. There is also a programme/service called “Matriciamento em Saúde Mental” which is a model of delivering healthcare where two or more professional teams create a proposal of a pedagogical-therapeutic intervention. In Brazil, this model is developed between the Family Health Strategy (reference team) and a supportive mental health team (in the case of dementia). The aim is to make the system less hierarchical by providing a specialized technical support to an interprofessional team so as to broaden their field of action and to qualify their actions (Brazilian Ministry of Health, 2011b).

References:

Brazilian Ministry of Health. (2011b). Guia prático de matriciamento em saúde mental. http://bvsms.saude.gov.br/bvs/publicacoes/guia_pratico_matriciamento_saudemental.pdf

Brazilian Ministry of Health. (2012). Política Nacional de Atenção Básica. http://189.28.128.100/dab/docs/publicacoes/geral/pnab.pdf

The Government adopts a multi-disciplinary and cross-sectoral approach in the provision of dementia care services. The Mental Health Review Report (MHRR) presents integrated service components within the existing care for persons with dementia. A table summarising these components can be found in p.174 of the report (Food and Health Bureau, 2017a, p. 174).

Besides, it proposes a medical-social collaboration model to deliver care services along to the continuum of care at different stage of dementia in a more cost-effective and sustainable way. The model can be found at p.181 of the report (Food and Health Bureau, 2017a, p. 181).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Not applicable.

PERDOSSI recommends care pathways that enable people with dementia (and their families) to have access to assessments through multidisciplinary teams as well as to psychosocial interventions. It is recommended that each patient suspected to have dementia at primary care level should be referred to the specialistic/secondary level of healthcare (neurology/psychiatry/geriatrics) or a memory clinic. Memory clinics should have multidisciplinary teams including neurologists, psychiatrists, geriatricians, psychologists, nurses, occupational therapists, physiotherapists, and (additional) general practitioners, home care workers, nutritionists, social workers, speech therapists, pharmacists, and local Alzheimer group representatives. The guideline does recommend one care provider to be the key care coordinator (PERDOSSI, 2015).

References:

PERDOSSI. (2015). Panduan Praktik Klinik: Diagnosis dan Penatalaksanaan Demensia. PERDOSSI.

Not applicable due to a lack of an established dementia care pathway in the public health sector.

Similar to mental health care, dementia care is not well integrated within health care delivery systems. Mental health care, which also covers dementia care is only provided in 29 of the 284 Level 4 hospitals and above but only few hospitals have a multidisciplinary team (psychiatric nurses, social workers, psychologists and medical doctors). There is also no structured needs assessment on the person with dementia and the caregiver. Often, the first point of entry is the outpatient clinic where a doctor gives a diagnosis and recommends referral to a psychiatric nurse for further psychosocial management after pharmacological and non-pharmacological prescription by the doctor. A care plan is then developed by the nurse or the psychologist rather than with the patient (focus group discussion with health care workers through the STRiDE project). There are no documents illustrating the existence of this process.

As mentioned above, there are no national dementia policies and no care coordination mechanisms are in place.

As described earlier, the NZ dementia framework was rolled out as a guide that DHBs could use in their work with primary, secondary, and community health and social support services to develop clear, consistent, well-resourced, and easily accessible dementia care pathways. The aim of the framework was to promote national consistency in dementia care while allowing for flexibility to adapt to local priorities and encourage innovation. Nine regional dementia pathways were subsequently developed, providing local guidance on the assessment, management, and ongoing support for people with dementia and their family/whanau. These pathways provide guidance on care coordination and case management for the associated regions.

Support services for persons living with dementia in South Africa are largely provided by the non-governmental organisation (NGO) sector, for example Alzheimer’s South Africa (ASA) and Dementia-SA.