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Czech Republic

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

Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

The Czech Alzheimer Society lobbied many branches of the government to set up a National Dementia Strategy. The government finally agreed to create one in 2010.

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

The Czech Alzheimer Society has been very active from the very beginning. It repeatedly addressed the Prime Minister in 2009 and also Ministers of Health and the Minister of Labour and Social Affairs etc. In October 2010, the Government of the Czech Republic decided that an “Alzheimer Plan” would be developed. Ministries of Health, Social Affairs, Education (which is responsible for research) and Justice were ordered to prepare a concept to enable the Government to proceed with the preparation of the National Dementia Strategy (Plan Alzheimer).

The Czech Alzheimer Society asked for the collaboration of many professionals and prepared a list of suggested priorities for the future Dementia Strategy based on discussion with physicians (neurologists, GPs, geriatricians and psychiatrists), family caregivers and people with dementia, lawyers, social workers, nurses etc. Officers from the Ministry of Health (responsible for the conception of the Strategy) also participated in these discussions. After a difficult political situation lasting two years, the conception was accepted by the Government of the Czech Republic in October 2012. It was decided to invite a group of interested persons including specialists to prepare the National Dementia Strategy. It is presumed that the Czech Alzheimer Society (and also new Alzheimer Foundation) will play an important role in this process.

The Czech Alzheimer Society continues to support the Strategy with media campaigns for better awareness. These campaigns are also targeted at municipalities.

Diagnosis, treatment and research

Issues relating to diagnosis

Which healthcare professionals are responsible for diagnosing dementia

GPs are expected to carry out basic screening of cognitive functions, but this is not specified in any guidelines. There are principles of care in guidelines that were prepared by an expert group of GPs, neurologists, psychiatrists and geriatricians including representatives of the Czech Alzheimer Society. GPs should also make a basic diagnosis and then refer patients to a specialist for a full diagnosis. This could be a neurologist, psychiatrist or geriatrician.

Dementia is not still a care priority for general practitioners. They have to focus in their practice on many other difficult problems. Therefore, they often underestimate the importance of the timely diagnosis of dementia.

Type and degree of training of GPs in dementia

The Czech Alzheimer Society, together with the School of Long-term Care Medicine of the Postgraduate Medical Institute, organises courses for GPs and for physicians working in long-term care settings. A course on dementia has become part of postgraduate specialisation training for GPs. GPs therefore receive three hours of theoretical training in dementia during their postgraduate specialist education. A range of voluntary courses are also available.

Required tests to diagnose dementia

The MMSE test is used in the diagnosis of dementia. This is necessary if AD drugs are to be prescribed. GPs are not obliged to use this for their initial basic diagnosis. They might but it is sufficient that they refer patients to specialists based on their clinical impression.

As mentioned earlier, a group of psychiatrists, neurologists and geriatricians, including members of the Czech Alzheimer Society, published recommended guidelines for the diagnosis and treatment of dementia, both generally and also in general practice.

Issues relating to medical treatment

The availability of medicines in general

In the Czech Republic, medicinal products are classified into three categories and reimbursement varies from 0 to 100%. The first category is fully covered and includes the cheapest effective preparations of all essential products. For medicines in the second or third category, patients need to either partly or fully co-finance the costs of the medicines.  There is nevertheless a regulatory charge of CZK 30 (EUR 1.17) for every drug prescribed irrespective of whether it is partly or fully reimbursed by the public health insurance system. The regulatory charge is waived in certain cases which include people living in homes for disabled people or for older people (if their “minimum income remainder” is less than CZK 800 (EUR 31) or if they have been proved to be in material need.[1]

The availability of Alzheimer treatments

All four AD drugs are available in the Czech Republic and are part of the reimbursement system.

Conditions surrounding the prescription and reimbursement of AD drugs

The Czech Republic limits reimbursement of AD drugs to prescriptions filled in by specialists (neurologists, psychiatrists and geriatricians) both for initiation and continuation decisions of these treatments. Furthermore, acetylcholinesterase inhibitors are limited to patients with an MMSE score between 20 and 13 and memantine to patients with an MMSE score between 16 and 6. There are no formal reimbursement restrictions for people living alone or in nursing homes. However, these people are disadvantaged by the system which governs the funding of nursing homes. These do not exist as a combination of health and social care but are divided between systems of health and social care. In the first group, budgetary restrictions often reduce the use of these drugs. With the second type of care, there are many restrictions for prescribing physicians and access to specialists is very limited. Therefore, in these institutes cholinesterase inhibitors and memantine are very rarely prescribed and not according to the real needs of patients.

Not all specialists are willing to prescribe drugs so the Czech Alzheimer Society carries out memory days to offer free screening of cognitive disorders. People can be referred directly to specialists. By carrying out these memory days, the Association has significantly increased the number of people who can be treated because GPs cannot prescribe AD drugs, whereas specialists can.

Prescription and reimbursement

Donepezil

Rivastigmine

Galantamine

Memantine

Available

Yes

Yes

Yes

Yes

Reimbursed

Yes

Yes

Yes

Yes

Initial drugs reimbursed if prescribed by

Specialist

Specialist

Specialist

Specialist

Continuing treatment reimbursed if prescribed by

Specialist

Specialist

Specialist

Specialist

Required examinations

MMSE

MMSE

MMSE

MMSE

MMSE limits

20-13

20-13

20-13

16-6

Issues relating to research

Research is located mainly in universities and in some institutes.  Mostly research in basic science is carried out by the Czech Academy of Sciences.  There is also some interesting research being carried out in memory and neurological departments as well as research into genetics. A new comprehensive research centre is under construction. Also, the Czech Republic has some studies in dementia being carried out in university medical facilities in the departments of neurology, psychiatry, geriatrics and humanities. In the faculty of humanities, the focus is on research into long-term care and into the provision and management of services.  There is also on-going research being carried out by neurologists and geriatricians who have the ability to foster new research.  The new palliative society and the specialisation by doctors in long-term care also give rise to new research.

There are some minor agencies which provide funding for research but the main source is from the grant agency of the Czech Republic which provides funding for basic research and the Ministry of Health grant agency which provides funding for applied research.

International research is funded by the Ministry of Education, Youth and Sport. However, the whole system of research funding in the Czech Republic is based on regular public competition and therefore it is difficult to comply with the terms of the JPND. This results in a split between the funding allocated which has proved problematic and a case in point is the funding for Joint Programming. It remains unclear whether the Czech funding is for international collaboration or for national projects. There have been lengthy discussions on this issue which have led to delays and missed deadlines. The Czech Republic is not very involved in international projects, which tend to focus on big themes from Western Europe. It has been joining forces with other interested parties from Central and Eastern European countries with the aim of jointly applying for international research grants on dementia.  It is very important to the Czech Republic and other EU countries as well.

The Czech Republic is involved in the EU Joint Programme – Neurodegenerative Disease Research (JPND) and is a Collaborator in the Joint Action “Alzheimer Cooperative Valuation in Europe (ALCOVE)”.

References

www.alzheimer.cz (Website of the Czech Alzheimer Society)

www.alzheimernf.cz (Wesbsite of the Alzheimer Foundation)

Franková, V., Hort, J., Holmerová, I., Jirák, R., Vyhnálek, M. (2011).Alzheimerova demence v praxi. Konsenzus psychiatricko-neurologicko-geriatrický. Praha. Mladá fronta, ISBN 978-80-204-2423-5

Holmerová, I., Vaňková, H., Jurašková, B. (2009). Management demence v praxi.Medicína po promoci, 10, 3, 93-98

Acknowledgements

Iva Holmerová, Chairperson, Czech Alzheimer Society,  Vice Chairperson of the management board of the Czech Alzheimer Foundation

[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

 

 
 

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
 
 

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