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Norway

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

Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

In 2006, the Norwegian government issued Report nr 25 (2005-2015) to the Parliament – Care plan 2015. Dementia was one of the elements in focus in this strategy and in 2007, the Ministry of Health and Care Services launched the Dementia Plan 2015 as a sub-plan to Care Plan 2015. The Dementia Plan 2015 includes a 4-year action plan. In 2011, the action plan was revised.

Duration of the National Dementia Strategy

The Dementia Plan officially started in 2007 and runs until 2015.

How the National Dementia Strategy is funded

The Dementia Plan 2015 is funded by the Norwegian government. Unfortunately, in the first years of the plan period, the funding was limited. From 2012, the government granted NOK 200 million (approx. EUR 262,000). The main grant was given to establish day programmes in the municipalities. NOK 15,000 was aimed at establishing carer support and educational programs in the municipalities. After 18 months, 72 % of all Norwegian municipalities provide an educational or support program for family carers

Provisions or procedure for implementing the Strategy

The national government uses both law and grants to meet the goals set in the Dementia Plan 2015. The main executer is the municipalities.

Procedure for monitoring progress made in achieving the goals set

“Ageing and Health”, the Norwegian Centre for Research, Education and Service Development, was assigned by the Ministry of Health and Care Services to monitor and report on status. The last report was made in 2011 and shows that although some progress has been made, a lot of challenges still remain.

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

The Norwegian Alzheimer Association was involved in the development as an advisor to the government. Regarding implementation, the Norwegian Alzheimer Association has received some financial support for its dementia help-line and for its information efforts, training for primary carers and support groups organised by the local branches. The Norwegian Alzheimer Association is also an important lobbyist for implementation of the national strategies, mainly for the Parliament.

Alzheimer association’s overall assessment of the National Dementia Strategy

The Norwegian Alzheimer Association regards the Dementia Plan as a description of best practice for public dementia care and services. If Norway manages to meet all the goals set in the plan, dementia care will be satisfactory. However, the Norwegian Alzheimer Association acknowledges that there is still a long way to go before all the goals set by the action plan are met.

Diagnosis, treatment and research

Issues relating to diagnosis

Timely diagnosis in the National Dementia Strategy

The Dementia Plan acknowledges that approximately 50% of all users in nursing homes with sure signs of dementia have not been diagnosed. In the Dementia Plan, it is stated that this is partly due to lack of expertise in the health and care services. It is further claimed that the solution is to increase knowledge and improve skills through various training programmes.

Models for evaluating and diagnosing people with dementia are to be developed in partnership with specialists and municipal health services. This will include the development of routines to ensure collaboration between local authorities and specialist health services with regard to evaluation, diagnosis, interdisciplinary advice and guidance, the sharing of expertise and improved follow-up of people with dementia.

Which healthcare professionals are responsible for diagnosing dementia

Dementia can be diagnosed by a GP or a specialist. GPs normally have 15 to 20 minutes’ consultation time. They can, however, plan a longer time and organise multiple consultations, which is recommended when diagnosing dementia. There are some guidelines regarding the use of questionnaires and the assessment but no incentives linked to diagnosis.

Type and degree of training of GPs in dementia

According to the Norwegian Board of Health and Norwegian Medical Association (2000), medical training is offered by the universities of Oslo, Bergen, Tromsø and Trondheim. Courses, which lead to a degree in medicine,  normally last six years and are followed by 18 months' compulsory preliminary internship (turnustjeneste). This consists of a set period working in hospitals and a set period working for a municipal health service. General medicine is one of 42 medical specialties. However, it is not mandatory to specialise in general medicine in order to become a GP in Norway. Those who do train for this specialty can, to a large extent, choose the areas of medicine on which they would like to focus. The mandatory parts of the specialist training are fairly general, covering issues such as communication, research and quality etc. GPs therefore need to be aware of and search for the knowledge needed for their practice.

Specialists in general practice have to recertify every 5 years. However, it is not necessary to be a specialist in general medicine to be a “fastlege”. A “fastlege” is a GP who has a list of patients who have registered through their municipality to have him/her as their regular GP. The GP then prioritises those patients and receives a fixed compensation per listed patient (Overland et al., 2008).

Required tests to diagnose dementia

The MMSE is used to diagnose dementia. This is recommended by the Ministry of Health and Care Services. There are a few recommendations covering the diagnosis of dementia. Links to the recommendations (which are in Norwegian) are listed below:

http://www.aldringoghelse.no/ViewFile.aspx?itemID=2806  (recommended diagnostic tool for use at residents in living institutions)

http://www.aldringoghelse.no/ViewFile.aspx?itemID=1481  (recommended diagnostic tool for GPs)

http://www.aldringoghelse.no/ViewFile.aspx?itemID=1492  (recommended diagnostic tool for dementia teams e.g. specialized healthcare professionals in municipalities)

Issues relating to medical treatment

Medical treatment in the National Dementia Strategy

The issue of medical treatment is scarcely addressed in the Dementia Plan 2015. It states a need for better routines and more knowledge in the municipal health and care services. The importance of milieu therapy and treatment is acknowledged as a development programme.

The availability of medicines in general

The Norwegian system differentiates between important and less important medicines.

For less important medicines, the patient pays the full cost, even if they have been prescribed by a doctor. Nevertheless, under certain conditions, it is possible for patients to claim a refund of 90% of all costs exceeding NOK 1,600 (approx. EUR 205)[1].

For drugs on the important medicines list, patients are required to pay 38% of the cost. This only applies to the cost of drugs up to a ceiling of NOK 520 (approx. EUR 67) for a three-month period. The part not paid by the patient is paid by the National Insurance by means of a direct settlement with the pharmacies. Pensioners in receipt of a minimum pension or disability pension do not need to pay cost-sharing charges for important medicines and nursing articles.

The availability of Alzheimer treatments

All four AD drugs are available in Norway.

Conditions surrounding the prescription and reimbursement of AD drugs

Memantine is not on the list of important medicines and is thus not reimbursed. Nevertheless, the Norwegian Alzheimer’s association explains that it is possible for doctors to fill out a form for memantine indicating that the drug is important and needs to be taken over a long period of time. In such cases, memantine can be partially reimbursed with a part of the costs borne by the patient. The other three AD drugs are reimbursable. Norway does not limit the prescription of AD drugs to specialist doctors, since the rules only state that the physician must have an interest in and knowledge about dementia. A diagnosis of Alzheimer’s disease and an MMSE score over 12 are the only requirements for the reimbursement of acetylcholinesterase inhibitors. Also, the Norwegian system reimburses medicines for people living alone or in nursing homes.

Prescription and reimbursement

Donepezil

Rivastigmine

Galantamine

Memantine

Available

Yes

Yes

Yes

Yes

Reimbursed

Yes

Yes

Yes

 It depends

Initial drug reimbursed if prescribed by

No restrictions

No restrictions

No restrictions

Restrictions

Continuing treatment reimbursed if prescribed by

No restrictions

No restrictions

No restrictions

 

Required examinations

MMSE

MMSE

MMSE

 

MMSE limits

> 12

> 12

> 12

 

People living alone

No restrictions

No restrictions

No restrictions

No restrictions

People in nursing homes

No restrictions

No restrictions

No restrictions

No restrictions

Issues relating to research

Research in the National Dementia Strategy

The Dementia Plan 2015 acknowledges the need for and importance of research. A dedicated research programme has been established under the direction of the Research Council of Norway but with limited funding and only regarding care related research.

Nevertheless, R & D projects were implemented during the period of 2007 to 2010 by the Norwegian Directorate for Health with a grant of NOK 5 million each, focusing on younger people with dementia, people with dementia from minority language backgrounds, people with dementia from the Sami population and the treatment of people with dementia with challenging behaviour living in residential care (Engedal, 2010). 

Any additional medical or scientific issues covered in the National Dementia Strategy

The Dementia Plan describes several. The government wishes to develop dementia care as an integrated and continuous chain of measures. The services need to be adapted to the individual’s functioning level and service need. This includes day care programmes (e.g. considered a main challenge in Norwegian care), support and guidance for family care givers and care staff, support groups, systematic information efforts to the public and boosting of the quality and frequency of nursing homes.

In addition to public funding, the Norwegian Alzheimer Association collect funding for PhDs and running costs related to dementia research.  In 2012, 4 PhDs are underway.

Norway 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

Engedal, K. (2010), The Norwegian Dementia Plan 2015 – “making the most of the good days”,International Journal of Geriatric Psychiatry, 25, 928-930

Norwegian Board of Health Faculty of Medicine, University of Oslo and Norwegian Medical Association (2000),Report on the registration of medical practitioners in Norway

Overland, R., Overland, S., Johansen, K.N. and Mykletun, A. (2008), Verifiability of diagnostic categories and work ability in the context of disability pension award: A survey on “gatekeeping” among general practitioners in Norway,BMC Public Health, 8, 137

Acknowledgements

Anne-Kjersti Toft, Political Advisor, National Alzheimer Association

May-Hilde Garden, Dementia Advisor, National Alzheimer Association

[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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