Basket | Login | Register

 
 
 
 

Switzerland

2012: National Dementia Strategies (diagnosis, treatment and research)

Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

On 12 March 2012, the Swiss Council of States (the upper house of the federal Parliament), following the positive decision of the Swiss National Council (the lower house of the federal Parliament), approved a series of proposals which effectively call upon the federal government and the cantons to prepare a national dementia strategy. The next step will be to establish priorities and assign action items to regional authorities and associations.

Involvement of the Swiss Alzheimer Association (and/or people with dementia)

The Swiss Alzheimer Association is an active supporter for a national dementia strategy and has proposed that the following be included:

• promotion of professional training (for GPs and other health professionals) to improve timely diagnosis, early intervention and advice for people with dementia and their carers;

• support for family caregivers, and available, affordable and adequate services all over Switzerland;

• campaigns to raise awareness within society.

Diagnosis, treatment and research

Issues relating to diagnosis

Which healthcare professionals are responsible for diagnosing dementia

GPs are permitted to diagnose dementia and/or Alzheimer’s disease but in situations where they are uncertain, it is recommended that they refer patients to specialists (such as neurologists or geriatricians) or memory clinics which also make diagnoses.

In Switzerland, there is a system known as Tarmed which stands for “tarif médical”. Every medical act has a value in points which is calculated based on the time needed, the difficulty of the task and the infrastructure needed. The points are converted into a monetary value which is fixed by each Canton.

The special act of “cognitive analysis and advice” allows for 60 minutes. This can only be charged by specialists, not GPs. The latter can only charge for advice and other acts.

GPs cannot therefore charge for longer consultations based on the fact that a person has dementia or suspected dementia.

There are no incentives for GPs to improve or increase timely diagnosis at federal level. However, some Cantons offer continuing education in dementia for GPs.

Type and degree of training of GPs in dementia

The amount of training in dementia that GPs receive in the course of their professional training to become a GP differs from one university to the next. Dementia is included in courses on psychiatry, geriatrics and internal medicine. GPs are obliged to do 80 hours of continuing education per year but not specifically in dementia.

Required tests to diagnose dementia

There are as yet no official guidelines or recommendations which must be used in order to diagnose dementia and/or Alzheimer’s disease. A consensus on the diagnosis and treatment of people with dementia has been approved by most dementia experts in Switzerland. This is the “Consensus 2012 on the Diagnosis and Treatment of Patients with Dementia in Switzerland”. It describes the state of the art regarding diagnosis and can be downloaded in French and German from the website of the Swiss Alzheimer Association at:

http://server25.hostpoint.ch/~alzch1/alz.ch/index.php/examen-et-diagnostic.html

http://server25.hostpoint.ch/~alzch1/alz.ch/index.php/abklaerung-und-diagnose.html

Issues relating to medical treatment

The availability of medicines in general

The Federal Office for Social Insurance draws up a positive list of pharmaceuticals for which the compulsory health insurance system will pay (the specialty list). Maximum prices are also set for these products.

The availability of Alzheimer treatments

All four AD drugs are available. There are no restrictions for people with dementia living alone or in nursing homes.

Conditions surrounding the prescription and reimbursement of AD drugs

AD drugs are part of the reimbursement system. Treatment decisions can be made by any doctor whether it is for treatment initiation or treatment continuation. The Swiss system requires the doctor to carry out an MMSE at the time of diagnosis, as well as a first follow up examination after three months which can then be followed by examinations every six months. Treatment with acetylcholinesterase inhibitors should be discontinued if the MMSE score falls below 10 and with memantine for MMSE scores under 3. Combined treatment is not reimbursed.

Prescription and reimbursement

Donepezil

Rivastigmine

Galantamine

Memantine

Available

Yes

Yes

Yes

Yes

Reimbursed

Yes

Yes

Yes

Yes

Initial drug reimbursed if prescribed by

No restrictions

No restrictions

No restrictions

No restrictions

Continuing treatment reimbursed if prescribed by

No restrictions

No restrictions

No restrictions

No restrictions

Required examinations

MMSE

MMSE

MMSE

MMSE

MMSE limits

Above 10

Above 10

Above 10

Above 3 but under 19

Issues relating to research

Switzerland is involved in the EU Joint Programme – Neurodegenerative Disease Research (JPND) but not in the Joint Action “Alzheimer Cooperative Valuation in Europe (ALCOVE)”.

References

Monsch, A.U. et al. (2012), Consensus 2012 sur le diagnostic et le traitement des patients atteints de démence en Suisse,Praxis, 101, 19, 1-12

Acknowledgements

Marianne Wolfensberger, Swiss Alzheimer Association

 

 
 

Last Updated: Tuesday 14 May 2013

 

 
  • Acknowledgements

    The above information was published in the 2012 Dementia in Europe Yearbook as part of Alzheimer Europe's 2012 Work Plan which received funding from the European Union in the framework of the Health Programme. Alzheimer Europe gratefully acknowledges the support it has received from the Alzheimer Europe Foundation for the preparation and publication of its 2012 Yearbook.
  • European Union
 
 

Options