Navigating the future of Alzheimer's care in Ireland - A service model for disease-modifying therapies in small and medium-sized healthcare systems

Background: A new class of antibody-based drug therapy with the potential for disease modification is becoming available for Alzheimer’s disease (AD). However, the complexity of drug eligibility, administration, cost, and safety of disease modifying therapies (DMTs) necessitates adopting new models of treatment and care pathways. A working group was convened to consider the implications of and health system readiness for DMTs for AD. Aims To describe a service model for the detection, diagnosis, and management of early AD in the Irish context and to provide a template for similar small-medium size healthcare ecosystems. Methods A series of facilitated workshops with a multidisciplinary working group, including Patient and Public Involvement (PPI) members, was carried out. This informed a series of recommendations for the implementation of new DMTs using an evidence-based conceptual framework for health system readiness based on (1) material resources and structures and (2) human and institutional relationships, values, and norms. Findings: We describe a hub-and-spoke model, which utilises the existing dementia care ecosystem as outlined in the Model of Care, with Regional Specialist Memory Services acting as central hubs and Memory Assessment and Support Services functioning as spokes for less central areas. We provide criteria for DMT referral, eligibility, administration, and ongoing monitoring. We propose that this model is replicable for other healthcare systems of comparable size and scope.