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 to 77% in community (p<.001). Cardiology and neurology were most frequent specialists. 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 a lead role as PPCs.