Quality of care provided to people with dementia: utilisation and quality of the annual dementia review in general practice

Connolly, A.; Iliffe, Steve; Gaehl, Ella; Campbell, Stephen; Drake, Richard; Morris, Julie; Martin, Helen; Purandare, Nitin

doi:10.3399/bjgp12x625148

Cited by 29 publications

(40 citation statements)

References 28 publications

(25 reference statements)

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“…[30][31][32] It has been shown that the quality of annual reviews done in primary care for dementia is suboptimal and, despite a high prevalence of vascular diseases, over one-quarter of individuals diagnosed with dementia are prescribed antipsychotic medications that are known to increase the risk of cerebrovascular accidents and mortality. 33 In the current study, the quality of care for vascular conditions and risk factors received by…”

Section: Introductionmentioning

confidence: 94%

“…33 In brief, primary care electronic and paper records of 1006 people with dementia from dementia registers of a stratified random sample of 52 general practices from five primary care trusts (PCTs) in Greater Manchester were examined by trained researchers, using a proforma tool designed and piloted for the study purpose. From these, 12 people who had revoked diagnoses or were deceased were excluded.…”

Section: Methodsmentioning

confidence: 99%

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Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Connolly

Campbell²,

Gaehl³

et al. 2013

Br J Gen Pract

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BackgroundVascular diseases contribute to the causation and progression of clinical dementia. AimTo evaluate the quality of medical care for vascular diseases provided to people with dementia, the patient and practice characteristics that influence quality, and to compare care with that provided to those without dementia. Design and settingObservational, cross-sectional review of primary care records of people with dementia from 52 general practices from five primary care trusts in the UK, and comparison with publicly available summary data on patients without dementia. MethodA total of 700 patients with ≥1 diagnosed vascular disease or risk factor were identified from dementia registers. Quality of care was measured on 30 indicators from the UK Quality and Outcomes Framework (QOF) for hypertension, coronary heart disease, stroke, diabetes mellitus, atrial fibrillation, heart failure, and smoking. Overall quality of vascular care was calculated for each patient with dementia. ResultsLevel of care received by people with dementia was significantly lower compared with those without dementia for 22 of 30 (73%) indicators; most notably for measurement processes such as peripheral pulses check and neuropathy testing for diabetes, and cholesterol measures for stroke. Among people with dementia, women, those in care homes, and those with fewer comorbid physical conditions and medications were associated with lower scores for overall quality of vascular care. ConclusionThe quality of medical care provided to people with dementia with regard to vascular diseases is not concordant with quality, as defined by the QOF. Research is needed to improve access to high-quality care.

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Section: Introductionmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Connolly

Campbell²,

Gaehl³

et al. 2013

Br J Gen Pract

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“…Ten 98,110,117,118,129,136,139,145,155,161 of the 11 studies found some evidence that people with dementia were less likely to receive the same quality of care or access to services as those without dementia. For instance, studies found that people with dementia were less likely to receive monitoring for diabetes-related problems 97,136 and had reduced access to treatment such as intravenous thrombolysis for stroke, 129 surgery for cataracts, 110 treatment for age-related macular degeneration (AMD) 98,117 or services for diabetes. 139,145 More details are provided in Table 4.…”

Section: Comprehensiveness and Equitymentioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…A small minority of GPs and practice nurses in this study described regaining some clinical autonomy by seeking opportunities to modify indicators to meet the needs of individual patients. While greater individual discretion in implementation of indicators appears to be attractive to the profession in terms of increased clinical autonomy, such flexibility may not lead to improved patient outcomes 30 and is potentially dangerous within the context of pay for performance, since it directly contradicts evidence on the importance of validity and reliability in developing performance indicators. 31 Calibrating the appropriate level of clinical autonomy is critical if pay for performance schemes are to have maximal impact on patient care.…”

Section: Implications For Research and Practicementioning

confidence: 99%

Implementation of pay for performance in primary care: a qualitative study 8 years after introduction

Lester

Matharu²,

Mohammed³

et al. 2013

Br J Gen Pract

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Quality of care provided to people with dementia: utilisation and quality of the annual dementia review in general practice

Cited by 29 publications

References 28 publications

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Implementation of pay for performance in primary care: a qualitative study 8 years after introduction

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