Rebate call for family consults in dementia diagnosis

A SPECIFIC Medicare item number should be allocated for GPs to consult with family members of individuals suspected to have dementia to facilitate earlier diagnosis, experts say.

The call follows this week’s publication of two separate reports on the need for diagnosing dementia early.

The World Alzheimer Report, produced by Alzheimer’s Disease International, found that only 20–50% of dementia cases were recognised in primary care in high income countries.

And a report from Alzheimer’s Australia, Timely Diagnosis of Dementia: Can We Do Better?, estimated that in Australia a firm diagnosis of dementia took three years after symptoms were first noticed.

Professor David Ames, director of the National Ageing Research Institute, said adding an informant interview item to the Medicare schedule for GPs to assess cognitive impairment would be worthwhile.

“If you actually look at how geriatricians and psychiatrists work with people who might have dementia, most of us focus a significant amount of the assessment on a conversation with a trusted family member,” said Professor Ames, who is chief medical adviser for Alzheimer’s Australia.

Professor Henry Brodaty, director of the dementia collaborative research centre at the University of New South Wales, agreed lack of time was a major barrier to GPs diagnosing dementia.

“[There’s] also an uncertainty about what the next steps would be after they make a diagnosis,” Professor Brodaty said.

Failure to diagnose early was a lost opportunity because patients could miss out trying symptom-relieving medications and setting in place legal and social arrangements, he said.

The Medicare schedule permits psychiatrists to use Medicare items for initial and follow-up consultations of 20–45 minutes to interview “a person other than the patient”.