DESK REVIEWS | 07.01.07. What are the links between primary care services, specialist care services and community/institutional care services supporting people with dementia?

DESK REVIEW | 07.01.07. What are the links between primary care services, specialist care services and community/institutional care services supporting people with dementia?

The links may exist, but they are not well coordinated and integrated. However, there is the Family Health Strategy that facilitates integration between the three levels of care and that supports any type of healthcare needed by the population.

The referral system is regulated through the Ministry of Health’s Regulation no. 1/2012 and no. 4/2018 as well as through the regulation Health Insurance Administration Body of Indonesia (Badan Penyelenggara Jaminan Sosial-Kesehatan (BPJS-Kesehatan)) which establish links between different levels of healthcare services. The referral system also regulates the type of services that can be provided in primary care and how patients can be referred to specialist care services, including dementia cases (there are 14 public hospitals with geriatric integrated care teams).

In primary care settings with a mental health clinic within the hospital, treatment for dementia focuses on reducing symptoms and improving the quality of life of the person with dementia by engaging caregivers. Pharmacological interventions are also provided to persons with dementia but with the help of the caregivers since the late stage diagnosis makes it difficult to sustain conversations with the person with dementia (Musyimi et al., 2019). Advice to caregivers by health providers is not always adhered to since different caregivers (some who may not have the full history of the individual) accompany the person with dementia to primary care settings (Sheilah, 2018).

References:

Musyimi, C., Mutunga, E., & Ndetei, D. (2019). Stigma and dementia care in Kenya: Strengthening Responses to Dementia in Developing Countries (STRiDE) Project. In World Alzheimer Report 2019: Attitudes to dementia (pp. 121–122). London, UK: Alzheimer’s Disease International. https://www.alzint.org/u/WorldAlzheimerReport2019.pdf

Sheilah, M. (2018). The Potential of SMS Based Automated Reminders Towards Adherence to Clinical Instructions for Dementia Patients: A case of Healthcare Givers. University of Nairobi.

There are no established links for dementia care, as no dementia diagnosis and management programs are in place. Given that health and social security institutions work using gatekeeping mechanisms where general practitioners or family doctors see all individuals first and then decide to send them to secondary or tertiary level services. This means that in some cases individuals will be referred to specialists if they are available, as very few positions of dementia specialists exist in health and social security institutions.

Currently in South Africa persons living with dementia and their families seeking care services from local practices (e.g., local general practitioners) are linked to dementia-care services provided by the NGO-sector and/or specialists in the private sector. These links are dependent on these local practices/individuals. Persons seeking help from PHC within the public sector may be referred to the Department of Social Development (DSD), who in turn relies on social partnerships with the NGO-sector to link individuals with community-based services. DSD may provide subsidies to these NGOs as a source of funding for services provided, and as a way of maintaining these links. There is policy support for designating responsibility for the provision of services to older persons by a third party, for example, the Older Person’s Act (no.13 of 2006, chapter 2, section 8(1)(a), p.6) indicates that the minister “…may provide financial awards to service providers that provide social services to older persons from funds appropriated by Parliament for that purpose” (Government Gazette, 2006). There was no information found to what extent this actually happens with regard to dementia-specific community-based services.

References:

Government Gazette. (2006). Older Persons Act, No.13 of 2006 (Vol. 13, Issue 1098). Available from: https://www.westerncape.gov.za/other/2012/3/older_persons_act.pdf

They are initiated by a health assessment at the primary care service and, based on that, people may be sent to more specialized services.

Public primary care facilities provide referrals to secondary/tertiary facilities. There is no established referral network between primary care services/specialist services and long-term care services in the country due to the limited availability of the latter.

The links are regulated through the Ministry of Health’s Regulation no. 1/2012 and no. 4/2018 as well as through the regulation Health Insurance Administration Body of Indonesia (Badan Penyelenggara Jaminan Sosial-Kesehatan (BPJS-Kesehatan)).

As previously stated, no links specific to dementia diagnosis and management are in place.

There is the Family Health Strategy Policy. Usually in the public service the primary care unit covered by this program has several healthcare teams. Each team covers an area and is responsible for the health of those living in that area.

The Ministry of Health’s regulation no. 74/2014 regulates the type of services, facilities, and resources an integrated geriatric unit should have. It also regulates that such services should be managed by an Integrated Geriatric Team, formed by the hospital director. The geriatric service is classified into sederhana, lengkap, sempurna, and paripurna types, ranging from very simple services to very comprehensive, respectively. The regulation stated that the team should be led by a geriatric specialist in the paripurna (highest) types, or an internal medicine specialist in the lower types (Ministry of Health Regulation No. 79/2014 on Geriatric Services in Hospitals (Permenkes No. 79/2014 Tentang Pelayanan Geriatri Di RS), 2014).

References:

Ministry of Health Regulation No. 79/2014 on Geriatric Services in Hospitals (Permenkes No. 79/2014 tentang Pelayanan Geriatri di RS). (2014). (Testimony of Ministry of Health Republic of Indonesia).

No dementia specific care is provided in levels 2 to 3. This means that referral is often made if the community providers or health care workers are not able to manage the conditions. Referral typically is made through a referral note and communication to higher levels of care. Sometimes patients refer themselves to the higher levels of care, bypassing the lower-level facilities either because they lack awareness on where to get the appropriate treatment or perceive those lower levels of care provide lower quality of care. The Kenya Health Sector referral Strategy outlines the roles of the providers (at the referral and receiving facilities) and ambulance crew for emergency referrals (Ministry of Health, 2014d). This strategy may not be specific for people with dementia but rather to all people in need of health emergency or referral services.

References:

Ministry of Health. (2014d). Kenya Health Sector Referral Strategy. Ministry of Health Division of Emergency and Disaster Risk Management Afya House. https://www.measureevaluation.org/pima/referral-systems/referral-strategy

 

No related protocols or policies are in place.