DOCTORS CRITICIZE GOVT'S NEW LONG-TERM CARE SYSTEM|50歲以上失智納長照 醫師批缺個管制度

The government's Long-term Care 2.0 initiative was launched on January 1st, including dementia patients above the age of 50 in the government long-term care program for the first time. But some doctors are criticizing the program for lacking a comprehensive case management system for dementia patients. They suggest that the government implement a community care model similar to that for diabetes patients in order to reduce the costs to society and the National Health Insurance system. There are about 260,000 dementia patients in Taiwan, but only 70,000 are certified as disabled. Many cases are hidden and undiagnosed. Some doctors are advocating for changes to current rules limiting the diagnosis and treatment of dementia to neurologists and psychiatrists. They say that family doctors should also receive the training to discover and treat dementia. ==TSAI PING-HUANG Neurologist, Yang-Ming University Hospital== Some people go to the same clinic since their childhood, so the doctor at that clinic has the most complete history for that patient. Here at the hospital, we need a lot more time to really get to know that patient compared to the family doctor at the clinic. Other doctors are criticizing the government's Long-term Care 2.0 system for covering dementia patients over the age of 50, but without a comprehensive case management system. They say that case managers for patients can help with referrals, non-medical treatments, and counseling for family members. They can also reduce the frequency of ER visits due to emotional outbursts. ==CHEN JUI-HSING Neurologist, Far Eastern Hospital== Elderly dementia patients often experience delusions, hallucinations, and anxiety. There's nothing that an ER can do about any of that. The most important thing is for the patient to get in touch with their doctor, who knows how to calm the patient down. Then an ER visit can be avoided. Doctors suggest that the community care model for diabetics can be adapted for dementia patients. They also say that a case management system that provides education to family members can reduce the cost to society and the national health insurance system. TRANSLATED BY：JOHN CHEN 國內失智症患者大約26萬人，但領有身心障礙手冊的失智者，卻只有7萬人，顯示還有許多病人隱藏在社區中、沒有被診斷出來，有醫師認為，目前健保署規定，只有神經內科及精神科醫師、才可做失智症評估量表及給藥，應該擴大、讓基層家醫科醫師也受一些簡單訓練，才能早期發現失智症患者，及早介入治療。 ==陽明大學附設醫院神經內科醫師 蔡秉晃== 從出生 從小 就只有在那家診所看診 所以他的病史在哪裡最完整 就在那個診所醫生那邊最完整 我們(醫院)所需要花的時間 去了解這個病人的時間 一定比基層醫生還要多很多 此外也有醫師批評，政府推動長照2.0，並首度將50歲以上失智症患者、納入服務對象，不過卻缺乏完善的個管制度，因為如果有失智個案管理師，就可以協助轉診、非藥物治療，以及提供家屬諮詢服務，也可減少失智患者因情緒不穩、半夜跑醫院掛急診的情況。 ==亞東醫院神經內科醫師 甄瑞興== 失智老人來講 常有妄想 幻覺 急躁不安 這時候你送去急診是沒有用的啊 但最重要是說 你當時怎麼聯絡到你的醫生 然後他跟你講沒有關係 急躁要怎麼安撫下來 你就不用去跑急診 醫師建議政府，應將失智症、比照糖尿病的社區整體照護模式，並建立失智個案管理師，提供病患家屬衛教服務，才可減少社會成本及健保資源。 記者 賴淑敏 吳其昌 台北報導