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Improving Access to Appropriate AD Care


Key opinion leaders consider effective ways to improve access to appropriate care for individuals with Alzheimer disease.

Neil Minkoff, MD: We talked about getting to the right clinician, and your journey of getting to the right clinician, and we also brought in race and the racial experience with the health care system and social determinants of health. It sounds like we keep coming back to access, access, access, and maybe access as an issue. In case you want to dance around, we can get back to access.

Your experience, Mr. Gasby, was that you had to bounce around the system quite a bit. Talk a bit about that. What do you think could have been done to improve access that you and your family went through? We can then talk about how to blow that out as we are looking at benefit design, accountable care organizations, and the like.

Dan Gasby: It was mentioned earlier about having people who are geriatricians who understand what is going on and having doctors better trained and knowing. Most people do not know the difference between a neurologist and a neurosurgeon, so you have a problem there with understanding and knowing. I had a conversation today about how there was a time when a general practitioner knew how to tell you what to do. Now there is so much specialization. If you are not aware, if people do not make you aware, or if it is not put out in a public forum, you do not know where to go. That takes time, and that time can be frustration, and that frustration can ultimately mean that you do not do anything, or you sit on your hands. We have to do a better job. We have to do a better job of explaining things. Let’s be candid: a lot of it is race-based. I saw it. I saw how people were treated, and I even saw in 1 particular instance where my wife was not treated well until they found out who she was.

As I said earlier, we are dealing with tough stuff, and we have to take it head-on. Collectively, there needs to be more information and more articulation about the various parts of what is going on with brain health. We have to talk about it, and we have to talk about the tough stuff. If we do not, then we are going to be in a loop, and we are not going to get anything solved.

The population is aging and expanding. We know 1 thing: there are going to be 40 million more people who are going to need cognitive help over the next 10, 20, 30 years. That is not going away; it is math. We are in an era where people do not want to talk, or they try to sweep science under the drug. It goes back to the fundamentals. We have to be more educated, and we have to articulate.

The other thing is that we have to get more people who are influencers, whoever they may be, talking about this malady that is coming, this tsunami, whether they are hip hop artists, actors, politicians, or musicians, because we have to reach a population that does not want to know until someone else tells them or it gets domesticated. We have to domesticate these things so that it is almost like brushing your teeth or wearing a seatbelt: it becomes part of the everyday understanding. If you get lucky, you get old, and if you get old, here are the things that you are going to have to deal with. And it is going to affect your pocketbook, it is going to affect your life, and it is going to affect your ability to have a second home, to put your kids through college, or to take a vacation, or you are going to live a shorter life, or you are going to be sicker because you are under stress. Those are the things that have to be discussed because it all starts with your brain.

Transcript edited for clarity.

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