How Alzheimer Treatment Delivery Must Evolve: Darla Chapman, DNP

At an Institute for Value-Based Medicine^® event in Portland, Oregon, Darla Chapman, DNP, ARNP, nurse practitioner, of the University of Washington School of Medicine, explored how emerging Alzheimer disease therapies are reshaping where and how care is delivered. In this interview, Chapman discusses the need to decentralize treatment through earlier diagnosis, greater primary care involvement, expanded infusion capacity, and new options such as home-based dosing to ensure broader, more equitable access. She also highlights the essential role nurse practitioners and multidisciplinary teams play in diagnosing, treating, and supporting individuals living with Alzheimer disease across the full continuum of care.

This transcript has been lightly edited; captions were auto-generated.

Transcript

How will sites of care need to evolve to bring these therapies to a wider population?

I think when we think about the way that we offer these treatments right now, they are still new; we're still learning how to be able to provide them and offer them to the greatest number of people. But I think the goal would really be to try to decentralize the care a little bit. Can we find ways to diagnose this disease sooner? Are there ways that we can involve primary care, for example, to do a blood-based biomarker and then refer—if it's positive—to a specialty medicine? Are there ways that we can expand infusion center access? Can we look at more telemedicine options or ways that we can formulate medications in the future that don't require infusions?

I know that at least one of the medications is now being offered as maintenance dosing at the end of treatment in a subcutaneous form, so patients would then be able to give it to themselves at home, and that would help with the logistics of being able to get to a major medical center for treatment. And then cost; they're quite expensive. Not everybody will be in a position to be able to afford them. And they just create some urban, rural, and socioeconomic disparities across the board.

What is the role of nurse practitioners and other multidisciplinary providers in Alzheimer disease treatment?

Nurse practitioners, I think, are perfectly positioned to fill gaps across the health care system, whether that be in primary care or specialty medicine. We can work alongside our physician colleagues to provide diagnosis and treatment and monitoring of individuals living with Alzheimer disease across the entire spectrum of the illness, as well as provide care and support to their care partners. It really does take a multidisciplinary team to care for this particular patient population, including, not limited to, primary care, neurology, psychiatry, geriatrics, internal medicine, palliative care. Individuals with Alzheimer disease are seen across multiple sites of care, and so everyone will have a role in supporting them and their loved ones along the way.

Watch the first segment of Chapman's interview.