Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

In 2010, the Ministry of Health of Slovenia formed a taskforce to prepare the first official document about dementia at national level. The taskforce consisted of dementia experts, representatives of Alzheimer Slovenia, members of other non-profit organisations and government officials. This taskforce evaluated the current state of dementia care and completed its task by the end of August 2011.

The two major conclusions of the first national document about dementia were the need to establish a National Dementia Centre and that the National Dementia Centre should develop a National Dementia Strategy in collaboration with all other interested parties. These conclusions were approved by the National Board of Psychiatrists and the National Board of Neurologists. The National Board of General Physicians appeared initially reserved with regard to this idea since they worried that an excess burden of dementia care would fall upon them. However, they eventually realised that within the National Dementia Strategy their role in dementia care would be reduced and become more transparent.

In September 2012, this programme, derived from the conclusions of the first national document about dementia and approved by the National Boards of Psychiatrists, Neurologists and General Physicians, was proposed to the Advisory Board of the Ministry of Health of Slovenia. Unfortunately, it was not approved due to disagreement from a small group of neurologists who had requested increased funding for their own, largely research-based, dementia programme and who failed to recognise that this programme was in their own interests. As a result, the programme proposing the development of the National Dementia Strategy was rejected instead of being approved and appropriately funded. An considerable amount of work will be needed to get the programme finally approved.

Diagnosis, treatment and research

Issues relating to diagnosis

Which healthcare professionals are responsible for diagnosing dementia

GPs diagnose dementia but a formal diagnosis of diseases causing dementia is made primarily by psychiatrists and neurologists. GPs have set consultation times of less than 10 minutes per patient. This could be extended and this is something that will be proposed in the National Dementia Strategy and will require negotiations with the insurance companies. Meanwhile, GPs are paid on the basis of a ten-minute consultation and would not receive any additional payment for any extra time spent with a patient.

There are currently three incentives in the planned National Dementia Strategy to improve or increase timely diagnosis. The first is to improve the education of GPs, the second to better integrate dementia screening tests into GPs’ environment and the third to introduce a comprehensive dementia care programme into GPs’ daily practice.

Type and degree of training of GPs in dementia

There are no formal requirements or organised training in dementia for GPs. Whilst there are meetings and workshops where GPs can learn about dementia, the lack of formal requirements and organised dementia training at national level is a major drawback with regard to their understanding of dementia care.

Required tests to diagnose dementia

Many tests are used to diagnose dementia ranging from the MMSE, the clock drawing test to longer, more complex tests such as the ACE-R. In theory, such tests should be used during the initial diagnosis and then every six months to monitor the efficacy of treatment and to prevent complications. However, there is no data on the number of doctors who do this. It is possible that many do not and consequently, this should be better monitored.

Issues relating to medical treatment

The availability of medicines in general

Pharmaceutical products are divided into three lists classed as positive, interim and negative^[1]:

Products in the positive list are 75% reimbursed and 100% in the case of children and some other categories;

Pharmaceutical products in the intermediate list are reimbursed at 10%;

Pharmaceutical products in the negative list must be paid for by the patient.

It is possible to take out a voluntary insurance to cover co-payments. For pharmaceutical products not contained in the lists, the full cost must be borne by the patient. All drugs used during hospital treatment are free.

The availability of Alzheimer treatments

All four AD dementia drugs are available in Slovenia and 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 prescribed by a psychiatrist or neurologist. There are no restrictions for continuing treatment decisions. A diagnosis of Alzheimer’s disease and an MMSE score between 10 and 26 are required for reimbursement of AD drugs. Nevertheless, the Slovenian Alzheimer association also explains that for patients with an MMSE over 26, reimbursement is possible if further more extensive neuropsychological tests show the cognitive decline of a patient which is consistent with Alzheimer’s disease.

Issues relating to research

Slovenia is involved in the EU Joint Programme – Neurodegenerative Disease Research (JPND) but not in the Joint Action “Alzheimer Cooperative Valuation in Europe (ALCOVE)”, although it would like to be, but an invitation has never been extended.

Acknowledgements

Stefanija  Lukič-Zlobec, Member of Alzheimer Slovenia – Spomincica, Dipl. OEDC, Employed at the Minitry of Finance

Gorazd Bernard Stokin, Assistant Professor of Neurology, MD, PhD, University Psychiatric Hospital and Division of Neurology, University Medical Centre Ljubljana

[1] European Commission (2012): 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