Early referral of Alzheimer's diagnoses to the First Link program can save the medical system time and money.
An early intervention referral program, First Link is a collaborative effort among primary care providers, Alzheimer Societies and other health professionals to support persons with Alzheimer's and related diseases following a diagnosis.
Once a physician makes a referral, the patient is called and offered support and information about the disease.
"Instead of waiting for them to call us, it enables us to pick up the phone and call them," explained Alison Denton, executive director, Thunder Bay Alzheimer Society. "It opens the door rather than people waiting for a time of crisis."
Within five days of receiving a referral, the referring physician is called to confirm that someone at the Alzheimer Society has established a "first link" with the patient.
Denton said the hope is to save patient visits to the family physician by providing the education and support necessary to help patients and their caregivers deal with the disease.
"The evidence is suggesting that early education and support means that people are able to cope at home longer and it delays the need for someone to enter the long-term care system. We know we can provide that non-medical intervention and linkages to other supports as well."
The most common form of dementia, Alzheimer's is a progressive, degenerative disease of the brain, which causes thinking and memory to become seriously impaired. It usually progresses over a long period of time.
The prevalence of dementia is anticipated to increase over the next few decades. A 2010 report called Rising Tide: Impact of Dementia in Canada predicted that the incidence of Alzheimer's disease and related dementias in Canada is estimated to increase from 103,700 new cases in 2008 (one every five minutes) to 257,800 new cases by 2038 (one every two minutes). The report states the economic burden of dementia will double every decade, increasing from $15 billion in 2008 to $153 billion in 2038.
A 2007 Canadian Institute for Health Information study identified Alzheimer's and related diseases as having the second highest impact on health-care costs among all neurological diseases, second only to strokes.
The First Link pilot project began in February 2007 in an effort to thwart escalating dependence on the health-care system. Funded by the Ministry of Health and Long-Term Care, it was tested in Kingston, Belleville, Prince Edward County, Grey-Bruce, Huron, Perth, Sudbury, Timmins and Ottawa.
The program focuses on crisis prevention by establishing links with patients and their caregivers earlier in the disease. The involvement of the Alzheimer Society with patients and caregivers is anticipated to be a lifelong commitment.
"I truly believe it is a best practice in dementia care," Denton said. "The qualitative evidence would support that. People are definitely feeling supported and that it is beneficial."
One of the tools used in the program is a five-module learning series. First Link-trained facilitators present it over a four-week period within a support group. The modules address the different stages of the disease, including palliative care, and how to tell family and friends.
Denton measures the success of the program by tracking the number of referrals (as many as two to three a day per week), the regularity of client participation in support groups, and testimonials.
One challenge has been getting physicians to obtain permission to refer a patient. Often, physicians simply talk about the program to the patient, but don't take the next step.
"It is not enough to tell the patient to call the Alzheimer Society, because they won't until they absolutely need us," Denton explained. "The key to the program is for us to contact them and provide that early education and support to build a relationship, so that when things get more challenging, they are known to the system and not hitting it at a point of crisis."
Another challenge is receiving consistent funding over an extended period of time. Presently, Thunder Bay's First Link program is funded on a yearly basis through the North West Local Health Integrated Network's Aging at Home Strategy.
Without a guarantee that the program will continue to receive annual funding, it is difficult to plan and promote it and hire staff.
Regardless of those uncertainties, Denton is passionate about the program and its long-term benefits, particularly as more demands are placed on a system that must come up with creative solutions to deal with an aging population.
www.alzheimerthunderbay.ca
