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Ireland

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

Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

According to the Chair of the Alzheimer Society of Ireland, the initial impetus for the launch of the Irish Dementia Strategy came from Alzheimer Europe's Paris Declaration. In 2006, the Irish association began lobbying MPs and influencers to make dementia a national priority.

This initial effort was not successful. However, a TV documentary about the poor living conditions of people with dementia provoked public reaction and restarted the debate. This was helped by an Irish Minister speaking out about the difficulties of caring for his wife, who was living with dementia. In addition, the Irish association received a grant that was used to fund a major communications campaign.

The national Irish dementia strategy is due to be launched in 2013.

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

The Alzheimer Society of Ireland campaigned with other NGOs in the age sector with a single voice. 

Diagnosis, treatment and research

Issues relating to diagnosis

Which healthcare professionals are responsible for diagnosing dementia

GPs can diagnose dementia, prescribe medication (which would be refundable) and make repeat prescriptions. They can also refer patients to specialists if they see fit. Referrals would be made to a psychiatrist of old age or a geriatrician. Neurologists do not generally deal with cases of dementia.

GPs have fixed consultation times of 15 minutes. It is possible to book a “double appointment” (i.e. 30 minutes) for which patients would be charged accordingly. Some GPs operate a discretionary policy around this, especially if they know the patient.

Type and degree of training of GPs in dementia

GPs receive one month’s training in psychiatry and one month in neurology.  Dementia is discussed in both of these areas, but it is not treated as a separate issue. All GPs are obliged to do CPD (continuous professional development) and have to obtain a certain number of points (calculated in hours) per year in order to retain their registration. The main trainer of GPs is the Irish College of General Practitioners (http://www.icgp.ie/). There are no incentives for GPs to improve or increase timely diagnosis.

Required tests to diagnose dementia

As long as a drug is approved (by the Irish Medicine's Board) and prescribed by a doctor, it qualifies for the medical card (an almost-free medicine scheme) and the drug payment scheme (the patient pays a ceiling price regardless of the cost of the drug and the state pays the balance). There is no diagnostic process involving obligatory tests that has to be adhered to in order for the drugs to be made available under either scheme, largely because there is no one national diagnostic process. There are recommended criteria but no national guidelines for the diagnosis of dementia. 

Issues relating to medical treatment

The availability of medicines in general

People with full eligibility must pay EUR 0.50 per prescribed item up to an amount of EUR 10 per family per month. Drugs prescribed for the treatment of a specified long-term illness are free of charge. Under the Drug Payment Scheme, no individual or family is required to pay more than EUR 120 per month for approved prescribed medicines and medical devices[1].

The availability of Alzheimer treatments

All AD drugs are available in Ireland and are part of the general system described above.

Conditions surrounding the prescription and reimbursement of AD drugs

There are no specific examinations which are required for medicines to be made available to patients, nor does the system provide upper or lower MMSE limits for the treatment with different AD drugs. There are no restrictions as to the access of people living alone or in nursing homes to available Alzheimer treatments. Finally, prescriptions can be filled in by any doctor and are not limited to specialists, be it for treatment initiation or continuation decisions.

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

None

None

None

None

MMSE limits

None

None

None

None

Issues relating to research

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

Acknowledgements

Maurice O’Connell, The Alzheimer Society of Ireland, Chief Executive Officer

Grainne McGettrick, The Alzheimer Society of Ireland, Research and Policy Officer

[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

 

 
 

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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