Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

In February 2012, the National Alzheimer Alliance was created and this was the first step in lobbying for a National Dementia Strategy. The Romanian Alzheimer Society was the main actor in this fight.

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

The Romanian Alzheimer Society has elaborated a manifesto which contains the action plan for a National Dementia Strategy and has already gathered 3,000 signatures in support of it.

Letters were sent to national policy makers asking them to establish an intergovernmental department/commission to work on this issue.

A lot of family members as well as people with dementia are also involved. They signed the declaration in which it is stated that there is an urgent need for a National Dementia Strategy and this was accompanied by a request for action.

Diagnosis, treatment and research

Issues relating to diagnosis

Which healthcare professionals are responsible for diagnosing dementia

There are huge difficulties in obtaining an early diagnosis.  GPs are not permitted to diagnose dementia and do not have set consultation times to evaluate people with cognitive impairment. There is a reimbursement system based on 15-minute consultations irrespective of the age or condition of the patient. GPs can be reimbursed for twenty consultations per day.

Psychiatrists, neurologists and geriatricians are permitted to diagnose dementia and/or Alzheimer’s disease. As with GPs, specialists have fixed reimbursements for consultations so there is no difference in the duration of the consultation or in the level of reimbursement that specialists receive for dealing with different conditions. There are currently no incentives to improve timely diagnosis.

Type and degree of training of GPs in dementia

In their professional training to become a GP, the curriculum contains a one-month period of training in psychiatry during their three years’ residency. Dementia is amongst the list of topics covered.

Continuing education is an obligation for GPs although courses on the diagnosis and management of patients with dementia are not mandatory. However, courses on this subject were provided during the information campaign for GPs and at conferences and congresses, many of which were carried out by the Romanian Alzheimer Society in major cities in Romania.

Required tests to diagnose dementia

The National Health Insurance approved guidelines that are in existence in Romania which prescribe a series of examinations that need to be carried out when making a diagnosis. These include neuropsychological tests, CT or MRI scans and laboratory tests.

The current “Guidelines for Dementia Diagnosis and Treatment” were published in 2009 with the approval of the Health Ministry. These guidelines were developed by neurologists and psychiatrists and undertaken by all the specialist doctors involved in the diagnosis and treatment of dementia (neurologists, psychiatrists, geriatricians).

Issues relating to medical treatment

The availability of medicines in general

Pharmaceutical products are reimbursed at different levels based on which category they have been allocated to. The National House for Health Insurance reimburses medical drugs on the following basis:

List A: 90% of the reference price covered.

List B: 50% of the reference price covered.

List C: C1 - 100% of the reference price covered; C2 – full price for drugs for HIV/AIDS and tuberculosis; C3 – 100% of reference price for certain group including people who are totally or partially unable to work^[1]. 

The availability of Alzheimer treatments

Medical treatment at national level is free of charge and it belongs to a National Plan concerning pharmacological treatment for chronic diseases and is still applicable, on C1 list 100% of reference price covered.

All AD drugs are available and reimbursable in Romania. Unlike other countries, donepezil is also indicated for the treatment of vascular dementia and can be reimbursed in those cases as well.

Although there are no restrictions for people living alone or for people living in nursing homes, the Romanian Alzheimer Society does report difficulties for these people in accessing medication due to a lack of social support available.

Conditions surrounding the prescription and reimbursement of AD drugs

Treatment initiation and treatment continuation are restricted to specialists (neurologists or psychiatrists). For AD drugs to be reimbursed, the series of tests mentioned earlier need to be carried out and included in a medical report.

Until recently, the system did not prescribe any upper or lower treatment limits either, but in some areas of the country, the Romanian Alzheimer Society reports that health insurance offices have restricted reimbursement to people with Alzheimer’s disease with an MMSE score over 10.

Issues relating to research

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

Acknowledgements

Gabriela Cirstescu, Executive Director, Romanian Alzheimer Society

Maria Moglan, Romanian Alzheimer Society

[1] European Commission (2011): MISSOC – Mutual information system on social protection : Social protection in the Member States of the European Union, of the European Economic Area and in Switzerland : Comparative tables