Treatment of Alzheimer's disease utilising the best available evidence-based medicine - Utopia?

Study Objectives: To practice evidence-based medicine is considered to improve health care, particularly of chronically ill patients. Taking Alzheimer's as an example the objective of this study is to explore as to how far ambulatory Alzheimer's patients receive the medical treatment with the best evidence available. Method: In 2000 and 2002 the health care situation of Alzheimer's disease patients was assessed by conducting telephone interviews with one hundred randomly selected general practitioners and specialists listed in the panel of the Institut fur Medizinische Statistik (IMS - Institute for Medical Statistics). By means of a standardised questionnaire the interviewees' prescriptions were assessed as well as their knowledge of the medical therapy for Alzheimer's and the use of non-medical therapeutic measures. Besides, the interviewees' prescriptions were checked on the basis of quantitative data taken from the IMS panel. Cholinesterase inhibitors (ChE-1), which are accorded the best evidence presently available in the medical treatment of Alzheimer's, were seen as a marker for the improvement of health care in the course of the study. Results and Conclusions: The interviewed physicians considered the evidence of medical Alzheimer's disease therapy with cholinesterase inhibitors high. 67% of the interviewees would use ChE-I as the drug of first choice if a near relative fell ill with Alzheimer's. However, the ChE-I prescriptions were limited to 13% in the base year 2000 and to 24 % in the base year 2002. Obviously, the implementation of this medical therapy is hampered by budgetary regulations. The interviewees find it particularly disadvantageous that the prescription of ChE-I may overstrain the budgets allocated to their practices. As a consequence, the effort to improve the quality of health care by implementing evidence-based medicine is thwarted by the increasing pressure on German physicians to prescribe drugs according to economic viability.