Guideline cuts Alzheimer’s care down to size
Guideline cuts Alzheimer’s care down to size
One-page tool ensures no need is overlooked
Physicians receive so many guidelines these days that rather than becoming tools to improve patient care they often collect dust. When the California Workgroup on Guidelines for Alzheimer’s Disease Management, sponsored in part by the Alzheimer’s Association of Los Angeles, set out to develop its "Guidelines for Alzheimer’s Disease Management," it was determined that the document would not suffer the same fate.
"We knew from the beginning that we wanted to develop a one-page guideline that primary care physicians could keep close at hand," says Debra L. Cherry, PhD, associate executive director of the Alzheimer’s Association of Los Angeles. "We realize that physicians don’t have the resources to meet all the needs of the Alzheimer’s patient. The tool suggests other members of the health care team and the community that are available to help the physician provide the care suggested on the guideline." (See guideline, p. 104.)
"The thing that’s very unique about this guideline is that it brings together in one place all the strategies for comprehensive Alzheimer’s care," notes Elizabeth Heck, LCSW, physician education and outreach manager for the Alzheimer’s Association of Los Angeles. "There are other Alzheimer’s guidelines, including one specifically for psychologists and one from the government on early recognition and assessment of memory loss. They complement this guideline. They fit inside the framework."
The one-page guideline is organized into four sections. A booklet that clarifies each of the components within the four sections, including suggestions for which member of the health care team is best suited to provide the suggested care or evaluation, accompanies the one-page guideline. The sections are:
• Assessment. The guideline recommends assessments of daily function, cognitive status, medical conditions, and behavioral problems. "Care managers, social workers, or nurses can perform much of the necessary assessment," Cherry explains. "As we work with managed care organizations to familiarize them with the new guideline, we emphasize that we expect physicians to work with other professionals to do any assessment or care that is not strictly medical."
• Treatment. The guideline includes recommendations for using the newest drugs available for management of cognitive decline and behavioral issues. It also suggests appropriate activities and therapies to help maintain and enhance daily function. Referrals to community service agencies and support groups also are recommended.
"Alzheimer’s must be addressed on three levels — biological, social, and psychological," notes Cherry. "Any interventions to support the patient and the family must also be on all three levels."
• Patient and caregiver education and support. "This is clearly where the care manager plays an explicit role," says Cherry. "But it’s up to case managers to educate physicians on their role. Unless case managers say that they have a role, and consumers demand better care, physician behavior won’t change. Case managers can be a tremendous support in making any guideline work, but they won’t have a role in the health care delivery system unless they educate physicians and the public on how they enhance patient care."
• Reporting requirements. Reporting laws vary from state to state, Heck says, such as reporting suspected abuse and submitting to restrictions on driving. "Care managers can be invaluable in helping physicians keep up with reporting needs, providing the appropriate forms, and making sure that the process is followed properly."
Putting them to use
Of course, a guideline is helpful only if it is used, Cherry and Heck point out. The workgroup developed an elaborate public relations and provider education plan to disseminate the guideline and encourage providers to use it. The guideline was introduced at a statewide conference held in April. "We invited the medical directors of managed care organizations and community resource organizations around the state," Cherry says. The guideline was introduced to a national audience in July at the Eighth Annual Alzheimer’s Dis ease Education Conference in Long Beach, CA.
"We have a two-pronged campaign planned — one for physicians and one for consumers," she says. "We want consumers to demand better care. We want them to say, Doctor, that’s not enough. I know there are more treatment options and resources available to help me cope with this disease.’ We hope to force doctors to work with partners, such as case managers, to meet their patients’ needs."
"We want to target a wide range of people who come in contact with this disease," adds Heck. "We are also developing additional tools to make the process even easier. We’re training physicians and other health care providers on how they can support the recommendations in the guideline. We’re explaining how they are integral to making the process run and move smoothly. We are educating the care manager, the social worker, the nurse, on what their role can be to help the process." If your staff come in contact with Alzheimer’s patients and their families, disease-specific training is essential. (See story, below.)
[Editor’s note: For more information, contact the Alzheimer’s Association of Los Angeles, 5900 Wilshire Blvd., Suite 1710, Los Angeles, CA 90036. Telephone: (323) 938-3379. Fax: (323) 938-1036.]
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