Pathways to care for people with dementia: An international multicentre study.

OBJECTIVE: The aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. METHODS: We recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centres for dementia care in 15 countries. The WHO "encounter form," a standardized schedule that enables data concerning basic socio-demographic, clinical, and pathways data to be gathered, was completed for each participant. RESULTS: The median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians, and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy, and practical advice) were delivered in less than 3% of situations. The analyses of the "pathways diagram" revealed that the path of PwD to receiving care is complex and diverse across countries and that there are important barriers to clinical care. CONCLUSIONS: The study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally, and internationally.

Effectiveness of a new low-cost psychosocial rehabilitative model to reduce burden of disease among persons with severe mental illness: An interventional follow-up study.

CONTEXT: Mental health disorders are an important factor contributing to the global burden to disease. Less than 1% of the health budgets in 62% of developing nations and 16% of developed nations are spent on mental health services. The availability of mental health rehabilitative services remains minimal. AIMS: This study aims to find the effectiveness of a new low-cost psychosocial rehabilitation model. SETTING AND DESIGN: The study was conducted at a rehabilitation center. An interventional follow-up study was designed. MATERIALS AND METHODS: A new low-cost psychosocial rehabilitative model was employed for 6 months for persons residing at a rehabilitation center. The World Health Organization Quality of Life (WHOQOL-BREF) instrument, WHO Disability Assessment Schedule (WHODAS) 2.0, and WHO (Five) Well-Being Index would be scored before and after the intervention. STATISTICAL ANALYSIS: The differences between the scores were analyzed using paired t-test or Wilcoxon signed rank test, whichever is applicable. P < 0.05 was taken as statistically significant. RESULTS: Sample size was 110. 29.1% were rehabilitated and 68.2% remained at the rehabilitation center at 6 months. The pre- and post-test scores using the new model showed improvement in the scores. The mean scores for WHO-BREF, WHO-5 score, WHODAS-2 score were 73.2, 51.14, and 20.34, respectively. On follow-up, the scores improved to 82.6, 67.09, and 15.96, respectively. CONCLUSIONS: The low-cost psychosocial rehabilitative model was found to be effective. This could serve as a model not only for other similar centers in India and but also for other low- and middle-income group countries.