Clinician type and care setting for treatment of Medicare beneficiaries with dementia

INTRODUCTION: Coordinating care for people living with dementia (PLWD) requires understanding which clinicians deliver care and the settings of that care. METHODS: We used the Medicare Carrier file to characterize the settings in which clinicians deliver care to PLWD, clinician types providing care, and whether clinicians record a dementia diagnosis. RESULTS: A total of 1,934,318 PLWD received care from 783,225 unique clinicians in 2019; PLWD saw a median of eight clinicians (interquartile range 5, 14). The most common settings were office (74.8% of PLWD), emergency room (63.9%), inpatient hospital (52.1%), and skilled nursing facility (37.1%). In addition, 87.0% of PLWD received care from a primary care physician, 62.9% from a nurse practitioner, and 33.1% from a physician assistant. Of the clinicians providing care, 2.4% are psychiatrists, 1.7% are neurologists, and 0.5% are geriatric subspecialists. DISCUSSION: Care for PLWD must be coordinated across multiple clinicians and settings, recognizing that few PLWD receive psychiatry, neurology, or geriatric subspecialty care.