Basket | Login | Register

 
 
 
 

Poland

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

Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

A National Dementia Strategy has been developed by the Alzheimer Coalition and presented to the Ministry of Health which promised to set up a working group which would accept the Strategy. Such a group has not been set up yet.  It is hoped that it will materialise this year.

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

The initiative to develop and formulate the National Dementia Strategy (National Alzheimer Plan) came from the Alzheimer Coalition which was established by the Polish Alzheimer’s Association. The Coalition consists of representatives of the Polish Agreement for Cooperation of the Polish Alzheimer’s NGOs, coordinated the Polish Alzheimer’s Association, and the Polish Alzheimer’s Society which groups specialists (medical professions and researchers).

Diagnosis, treatment and research

Issues relating to diagnosis

Timely diagnosis in the planned National Dementia Strategy

In the project of the National Dementia Strategy, the Polish Alzheimer’s Association has included a demand for an obligatory examination (MMSE) of cognitive functions for all people who are over 60. Such examination should be possible during a visit to a GP and this would hopefully result in the first signs of dementia being detected as early as possible and thus make timely diagnosis easier.

Which healthcare professionals are responsible for diagnosing dementia

There are no legal barriers in the State Regulation Concerning Basic Health Services issued by the Minister of Health which would prevent GPs from diagnosing dementia. There is no list of diseases either which should be diagnosed by specialists only.

In Poland, some GPs who suspect dementia treat patients themselves while others refer patients to specialists. The specialists who can diagnose dementia and/or Alzheimer’s disease are neurologists, psychiatrists and geriatricians.

GPs use screening tests like the MMSE and the clock drawing test to assess dementia provided that they possess the relevant knowledge and that such tests are available. Often, GPs diagnose dementia just on the basis of the consultation with the patient and/or family. Often, they do not attempt to diagnose a particular disease, like Alzheimer’s disease, and undertake treatment simply because they have no right to order an examination like a CT scan or psychological examination. Only a specialist can decide on that. Also, there is a fear that in the absence of a consultation with a specialist, the patient will not be entitled to purchase the drugs at a lower price with reimbursement from the state. If a GP prescribes drugs without a consultation with a specialist, the patient has to pay 100% as otherwise the GP would have to refund the cost of the treatment. Consequently, in practice, GPs either diagnose dementia and do not refer the patient to specialists or diagnose dementia but send the patient to a specialist for a more detailed, accurate diagnosis.  

There is no set consultation time in any regulations or agreements with medical staff. The duration of the consultation may differ according to the size of the clinic and the number of patients registered in it. Patients usually have an appointment for 15 minutes but on average they have ten-minute consultations. This depends on how many patients have appointments on a particular day, the season (i.e. there are more patients with colds in winter) and whether the doctor devotes any of his/her free time. Patients with pain, fever or something urgent do not need to have an appointment and have to be treated as if it were an emergency.

The consultation time can be extended but there is no regulation on this, so it just depends on the GP and the number of patients s/he has to consult on a particular day.

The National Health Service pays GPs who work in out-patient clinics, taking into account the total number of patients registered in a particular clinic but not how much work each GP does, how many patients s/he consults each day or how many diagnostic tests s/he carries out. The higher the number of older patients registered in a particular out-patient clinic, the more money the clinic receives. This is insufficient to serve as an incentive to GPs to devote more time to patients with dementia and thereby improve or increase timely diagnosis.

Type and degree of training of GPs in dementia

GPs are trained in different types of dementia, differential diagnostics and treatment during their first year at medical school and while attending neurology, psychiatry and internal disease lectures, seminars or classes during their six-year medical studies, as well as during their work in hospitals after completing studies.

During their studies at Warsaw Medical University, for example, they have in the third year, in addition to other subjects, 125 hours devoted to internal medicine and 45 hours of classes in laboratory diagnosis. In the fourth year, they have 161 hours on internal medicine and 60 hours on genetics, then 90 hours on neurology in the fifth year and finally, 120 hours on psychiatry and 30 hours on geriatrics in the sixth year. There is a general opinion, amongst GPs and specialists, that there are not enough hours on dementia in the training programme of medical students at Polish medical universities.

As with other doctors, GPs are obliged to develop their knowledge and skills and to obtain 200 points for continuing education in the four years which follow their qualification as a medical doctor. This is regulated by the Ministry of Health Regulation of 2004 on the ways to fulfil this duty to continue professional training. For example, a doctor can receive five points for his/her membership and involvement in a researchers' association/society or the same number of points for attending a conference.

Required tests to diagnose dementia

There are some guidelines issued by the Family Doctors' Collegium as well as by researchers' associations. There are no official guidelines from the National Health Service or Ministry of Health on diagnosing dementia. The Polish Alzheimer's Association has published and distributed a leaflet addressed to GPs with information prepared by leading specialists in the diagnosis and treatment of dementia outlining steps which should be taken when a GP suspects dementia. However, as in other specializations, there is no requirement for GPs to follow any guidelines to diagnose dementia and/or Alzheimer’s disease as recommendations in Poland are not obligatory for doctors. As diagnostic guidelines and tests are not available at every out-patient clinic, GPs usually refer patients with memory problems to specialists.

Medical treatment in the planned National Dementia Strategy

A demand has been made for full accessibility of drugs used in AD treatment. The drugs should be available free of charge or with 70% reimbursement.

The availability of medicines in general

Medicines in Poland can fall under one of three different reimbursement systems:

  • For basic medicines, patients pay a fixed price of PLN 3.25 (approx. EUR 0.82)  to PLN 5.00 (approx. EUR 1.27) as determined by the Minister of Health,
  • For special additional medicines, patients pay 30% to 50% of the cost,
  • For all other medicines, patients pay the totality of the cost.

Hospital medicines are free of charge.[1]

The availability of Alzheimer treatments

In Poland, all AD drugs are available, but only donepezil and rivastigmine are part of the reimbursement system. Recently, generic versions of donepezil have become available in Poland and reimbursement is limited to those generic versions.

Conditions surrounding the prescription and reimbursement of AD drugs

Treatment with acetylcholinesterase inhibitors is for people with MMSE scores between 26 and 10 and memantine for MMSE scores below 14. There are no restrictions in Poland for the reimbursement of these treatments for people living alone or in nursing homes. Also, prescriptions can be made by any doctor whether for treatment initiation or treatment continuation.

Prescription and reimbursement

Donepezil

Rivastigmine

Galantamine

Memantine

Available

Yes

Yes

Yes

Yes

Reimbursed

Only generic

Yes

No

No

Initial 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

No restrictions

No restrictions

No restrictions

No restrictions

MMSE limits

26-10

26-10

N/A

‹10

Issues relating to research

It is stated in the planned National Dementia Strategy that research studies in medicine and social consequences of AD should be developed as well as promoted and financed by the state. Poland is involved in the EU Joint Programme – Neurodegenerative Disease Research (JPND) but not in the Joint Action “Alzheimer Cooperative Valuation in Europe (ALCOVE)”.

Additional medical or scientific issues

The planned National Dementia Strategy includes research into community issues and other social and legal issues connected with living with dementia, as well as studies into the public awareness of dementia

Acknowledgements

Alicja Sadowska, Chair, Polish Alzheimer’s Association

Mirka Wojciechowska, Board member, Polish Alzheimer’s Association

Katarzyna Broczek, MD, Geriatrics Clinic at Warsaw Medical University

[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
 
 

Options