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Has the referral of older adults with dementia changed since the availability of acetylcholinesterase inhibitors and the NICE guidelines?

  • Christopher O'Loughlin (a1) and Jon Darley (a2)
Abstract
Aims and Method

To investigate whether patients with dementia are referred to specialist services earlier in the disease since the launch of acetylcholinesterase inhibitors and the publication of the National Institute for Clinical Excellence (NICE) guidelines for the use of these drugs. All referrals to old age psychiatry services in two 6-month periods in 1996 and 2003 were surveyed retrospectively for diagnosis, Mini-Mental State Examination (MMSE) score and use of acetylcholinesterase inhibitors.

Results

The mean MMSE score at referral increased from 18.8 to 21.5 (P=0.0005) between 1996 and 2003. Acetylcholinesterase inhibitors were prescribed for 35% of all patients and 58% of patients that would be suitable according to NICE guidelines in the 2003 group.

Clinical Implications

The earlier referral of patients with dementia to mental health services is encouraging.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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AD2000 Collaborative Group (2004) Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial. Lancet, 363, 21052115.
Audit Commission (2000) Forget Me Not. Mental Health Services for Older People. London: Audit Commission.
Audit Commission (2002) Forget Me Not, Developing Mental Health Services for Older People in England. London: Audit Commission http://www.audit-commission.gov.uk/Products/NATIONAL-REPORT/3DFEF403-038C-464f-8518-441477E92B15/forgetupdate.pdf
Department of Health (2001) National Service Framework for Older People. London: Department of Health.
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Malouf, R. & Birks, J. (2004) Donepezil for vascular cognitive impairment. Cochrane Library, issue 4, Oxford: Update Software.
McKeith, I., Del Ser, T., Spano, P., et al (2000) Efficacy of rivastigmine in dementia with Lewy bodies: a randomised, double-blind, placebo-controlled international study. Lancet, 326, 20312036
National Institute for Clinical Excellence (2001) Guidance on the Use of Donepezil, Rivastigmine and Galantamine for the Treatment of Alzheimer's Disease. Technology Appraisal Guidance, no. 19. London: NICE.
O'Brien, J. & Ballard, C. (2001) Drugs for Alzheimer's disease. BMJ, 323, 123–24.
Sheldon, T., Cullum, N., Dawson, D., et al (2004) What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews. BMJ, 329, 9991004.
White, C. (2004) NICE guidance has failed to end “postcode prescribing”. BMJ, 328, 1277.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Has the referral of older adults with dementia changed since the availability of acetylcholinesterase inhibitors and the NICE guidelines?

  • Christopher O'Loughlin (a1) and Jon Darley (a2)
Submit a response

eLetters

IMPACT OF NICE GUIDELINES on Memory Clinic Referrals has already been Studied

Dr. Zaffar Ul Hassan, STAFF GRADE Psychiatrist, Wakefield Memory Service
20 April 2006

O'Loughlin and Jon (Psychiatric Bulletin, April 2006 30, 131-134) have claimed that their study is the first to examine the changing patternof referrals after the release of NICE guidelines in 2001.

I would like to correct their assumption as while I was completing myMasters qualification from Kings College, London, the dissertation about The audit of waiting time of the memory clinic (Hassan, 2002) at FieldheadHospital, Wakefield, I covered the same areas of investigation. It was presented in the local audit meeting, distributed to neighbouring hospitallibraries and referenced in another study (Timlin, A et al-2005).

We studied the rate of referrals for a period of 6 months between 1stOctober 2001 and 31st March 2002. 130 patients were booked for the first assessment giving an average referral rate of 5 patients per week. A postal questionnaire was sent out to the local General Practitioners(GP’s)who had referred their patients for an assessment and possible treatment with an anti-dementia medication. One of the questions asked in the surveywas that, since its press coverage following the release of NICE guidelines, have you experienced more carer requests to prescribe these medications?

In our audit, overall GP’s response rate was 63%. Surprisingly, out of these only 30% answered Yes and 70% No. When we compared this answer with the rate of referrals received at our end, it showed that there was no set pattern of increase or decrease in referrals.

In our hospital-based clinic, the waiting time between the GP’s referral and first assessment was approximately 8 to 12 weeks. We also asked them to comment on the possible increase of waiting time. One of theGP’s comments was that we are only referring the tip of iceberg and another commented that we are aware that the waiting list is a problem; ifwe referred all suitable patients you could not cope.

One important comment was that if the waiting time increased anymore,he would not refer any more. This last comment had reflected an earlier finding by Startup (1994) that referring agents often stop requesting for services after acknowledging that a waiting list exists (Riordan and Mockler-1997).

One of the suggestions we received was to train and support the GP’s with special interest in Dementia. As pointed out by Connolly and Bullock (2003) in their study, there was some concern about the difficulty of identifying patients with mild disease and one may argue that in our studyit could be one of the reasons for not experiencing a huge rise in referral requests.

References:

O'Loughlin, Christopher, Darley, Jon (2006) Has the referral of olderadults with dementia changed since the availability of acetylcholinesterase inhibitors and the NICE guidelines? Psychiatric Bulletin 30: 131-134

Hassan, Z U (2002) An Audit of Waiting Time for a Memory Clinic, Master’s Dissertation, Kings College, London

Timlin, A et al (2005) Memory Matters: A report exploring issues around the delivery of anti dementia medication, The Ageing and Mental Health Research Group, The University of Huddersfield. ISBN 186218. Available from http://www.hud.ac.uk/hhs/research/amh/amhrg0105.pdf (accessed on 06/04.2006)

Connolly and Bullock (2003) Treatment of patients with Alzheimer’s disease: a national survey following release of the of the NICE guidance, Psychiatric Bulletin, 27, 11-13

Riordan, J and Mockler, D(1997) Clinical Audit in Mental Health, Towards a Multidisciplinary Approach. John Wiley & Sons, Chichester,U.K
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Conflict of interest: None Declared

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