Presentation (CTI)

OBJECTIVES: In Mexico, Alzheimer's disease lacks a national care pathway, and care is fragmented across healthcare levels. We mapped the patient care pathway to identify how fragmentation delays diagnosis, generates duplication of resource use, shifts care responsibilities to families, and creates foreseeable direct medical costs across the continuum of care.
METHODS: We conducted a qualitative study of 14 semi-structured interviews (2 general practitioners, 2 geriatricians, 2 neurologists, 2 psychiatrists, 1 social worker, 5 caregivers). Interviews were systematized into a care pathway map organized by clinical stage (mild, moderate, severe) and level of care (primary, secondary, tertiary), identifying barriers, waiting times, transitions, duplication of care, and points where fragmentation shifted continuity to caregivers.
RESULTS: Fragmentation was evident throughout the pathway. In primary care, cognitive symptoms were frequently attributed to normal aging, keeping patients in primary care for 2-5 years before a diagnostic pathway began. Referrals between levels involved waits of 3-6 months, and the diagnostic work-up a further 3-12 months. Transitions frequently repeated laboratory tests, cognitive assessments, and other completed evaluations, duplicating healthcare resource use. Many patients reached tertiary care only after substantial progression, when opportunities to modify disease trajectory were limited. Throughout, caregivers and civil society organizations functioned as the infrastructure sustaining continuity, compensating for limited institutional capacity. Caregiver burden was not assessed at any level, and progressive exhaustion frequently produced a need for mental-health and other medical services. Collectively, diagnostic delays, duplicated testing, and caregiver health consequences were foreseeable outputs of fragmentation.
CONCLUSIONS: Care pathway fragmentation generates predictable outputs of the current system, including diagnostic delays, redundant resource utilization, and caregiver health consequences that may translate into additional costs for the public health system. Findings suggest that value assessment frameworks should incorporate the costs of fragmentation and caregiver health consequences, to more fully reflect the burden the public healthcare system already absorbs.