Presentation (CTI)

OBJECTIVES: To examine access barriers to cognitive impairment associated with schizophrenia (CIAS) care across eight European countries and identify system-level insights applicable to broader complex disease management.
METHODS: A targeted literature review and semi-structured qualitative interviews (n=41) were conducted with healthcare professionals and health policy experts in Belgium, Denmark, Finland, Greece, the Netherlands, Norway, Portugal and Sweden. Rapid qualitative methodologies facilitated thematic analysis to identify recurring patterns and system-level enablers or constraints.
RESULTS: CIAS is under-recognised and undertreated due to a lack of practical standardised cognitive assessment tools, limited access to non-pharmacological interventions, workforce constraints and misalignment between reimbursement models and real-world functional outcomes. Countries with stronger community mental health services and value-based reimbursement frameworks were better positioned to support integrated care. Two distinct healthcare system archetypes emerged based on community infrastructure and reintegration policies. Findings suggest these barriers are not unique to schizophrenia and parallel access challenges in other complex therapeutic areas, such as oncology, chronic pain, metabolic conditions and rheumatoid arthritis, where fragmented care and outcome misalignment similarly hinder patient-centred delivery.
CONCLUSIONS: CIAS care illustrates how structural health system factors impede access to holistic, function-oriented care in complex conditions. Addressing these gaps requires systemic reform, including earlier intervention, multidisciplinary support, routine consideration of functional outcomes and reimbursement models that reflect patient-centred and societal value. Lessons learned in CIAS may help inform cross-sector strategies to reduce access inequities and improve long-term outcomes in complex diseases.