Objectives: To identify which clinical specialties are most central for care of people with dementia in the community and long-term care (LTC) settings.
Design: Cross-sectional analysis.
Participants: Fee-for-service Medicare beneficiaries aged ≥65 years with dementia.
Measurements: Specialty, categorized into primary care (internal or family medicine, geriatrics, or nurse practitioners [NPs]) versus other specialties, of the predominant provider of care (PPC) for each patient, defined by providing the most ambulatory visits.
Results: Among 2,598,719 beneficiaries with dementia, 74% lived in the community and 80% had a PPC in primary care. In LTC, 91% had primary care as their PPC compared with 77% in the community (P < .001). Cardiology and neurology were the most frequent specialties. NPs were PPCs for 19% of dementia patients in LTC versus 7% in the community (P < .001).
Conclusion: It is unknown whether specialists are aware of their central role for many dementia patients' care needs. In LTC, NPs play the lead role as PPCs.
Keywords: Medicare; Predominant provider; dementia; long-term care; primary care; specialist.
Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.