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Investigating the impact of primary care payments on underdiagnosis in dementia: a difference‐in‐differences analysis
- Authors:
- MASON Anne, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 33(8), 2018, pp.1090-1097.
- Publisher:
- Wiley
Objective: In England, two primary care incentive schemes were introduced to increase dementia diagnosis rates to two‐thirds of expected levels. This study assesses the effectiveness of these schemes. Methods: The study used a difference‐in‐differences framework to analyse the individual and collective impacts of the incentive schemes: (1) Directed Enhanced Service 18 (DES18: facilitating timely diagnosis of and support for dementia) and (2) the Dementia Identification Scheme (DIS). The dataset included 7529 English general practices, of which 7142 were active throughout the 10‐year study period (April 2006 to March 2016). We controlled for a range of factors, including a contemporaneous hospital incentive scheme for dementia. Our dependent variable was the percentage of expected cases (Edited publisher abstract)
Eating disorder diagnoses in general practice settings: comparison with structured clinical interview and self-report questionnaires
- Authors:
- ALLEN Karina L., et al
- Journal article citation:
- Journal of Mental Health, 20(3), 2011, pp.270-280.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
In Australia, there is a lack of information regarding the accuracy of eating disorder diagnoses made in routine primary care settings. This study evaluated the accuracy of eating disorder diagnoses made in these settings, and compared the accuracy of primary care diagnoses with those produced using patient self-report questionnaires. Two hundred and twelve referrals to an outpatient eating disorder programme participated. Primary care diagnoses were taken from referral letters and forms. Self-report diagnoses were generated using self-report responses to the Eating Disorder Examination-Questionnaire. Findings revealed that practitioners were accurate in identifying anorexia and bulimia nervosa, but inaccurate in identifying atypical presentations. In conclusion, unusual eating disorder presentations tend to be misdiagnosed in primary care settings, which have implications for the proper management of eating disorders within primary care settings.
Effects of educational interventions on primary dementia care: a systematic review
- Authors:
- PERRY M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(1), January 2011, pp.1-11.
- Publisher:
- Wiley
... diagnosis and management in primary care. The researchers concluded that educational interventions for primary care providers that require active learning and participation can improve detection of dementia in primary care, and that educational interventions need to be combined with social network strategies and financial reimbursement or other organisational incentives.
Survival of people with clinical diagnosis of dementia in primary care: cohort study
- Authors:
- RAIT Greta, et al
- Journal article citation:
- British Medical Journal, 14.8.10, 2010, p.337.
- Publisher:
- British Medical Association
Data from the Health Improvement Network (THIN), a primary care database was used for this study. Three hundred and fifty three general practices in the United Kingdom provide data to THIN. Participants were all adults aged 60 years or over with a first ever diagnosis for dementia from 1990 to 2007 (n=22 529); and a random sample of five participants without dementia for every participant with dementia matched on practice and time period (n=112 645). Results found the survival for people diagnosed with dementia aged 60-69 drops from an average of 6.7 years to 1.9 years in those aged 90 and over. Mortality rates are also more than three times greater in patients with dementia than in those without dementia in the first year after the diagnosis was recorded
The cost of diagnosing dementia in a community setting
- Authors:
- JEDENIUS Erik, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(5), May 2010, pp.476-482.
- Publisher:
- Wiley
In order to cope with the increasing number of individuals with dementia, it is crucial to develop the diagnostic capacity in primary care in cooperation with dementia specialists. Further, in order to establish prerequisites for care and planning it is important to identify the cost of dementia diagnosis. This paper describes a prospective, time- and resource utilisation study for the identification of the total cost associated with diagnosing dementia, from the start of the diagnostic process to the time for established or rejected dementia diagnosis, both at the specialist and primary care level. The studies looked at the Kalmar Dementia Program in southern Sweden in 2004, investigating the costs associated with 30 patients referred to primary care and 10 patients referred to a specialist memory clinic. The results showed that dementia evaluation in primary care took between 2 weeks and 2 months before reaching diagnosis. The cost for diagnosing dementia per diagnosed patient in primary care was estimated at 849 Euro. A patient referred to a specialist generates an initial cost of 656 Euro for the GP and an additional cost of 656 Euro for the specialist making a total of 1334 Euro. Based on this result it is estimated that the cost of establishing a dementia diagnosis is 1% of the total cost of dementia.
Recent trends in the incidence of recorded depression in primary care
- Authors:
- RAIT Greta;, et al
- Journal article citation:
- British Journal of Psychiatry, 195(6), December 2009, pp.520-524.
- Publisher:
- Cambridge University Press
Primary care is where most people with depression are managed in the United Kingdom. In view of the lack of data describing how general practitioners (GPs) record or label depression, this study aimed to show the incidence and sociodemographic variation in the recording of depressive symptoms and in depression diagnosis. Using 1996-2006 data from The Health Improvement Network (THIN), annual diagnosis and symptoms, was highest in females and in more deprived areas. The incidence of depression recorded by GPs is lower than that recorded in epidemiological studies although the trend in these towards a higher rate in deprived areas and among females is maintained. It appears that GPs may choose not to use diagnostic labels to define people’s illness but rather choose a symptom led approach.
Concordance with clinical practice guidelines for dementia in general practice
- Authors:
- WILCOCK Jane, et al
- Journal article citation:
- Aging and Mental Health, 13(2), March 2009, pp.155-161.
- Publisher:
- Taylor and Francis
This study aimed to determine general practitioners' concordance with clinical guidelines on the diagnosis and management of patients with dementia. The research used an unblinded, cluster randomized pre-test-post-test controlled trial involving 35 practices in the UK. Patients with a diagnosis of probable or confirmed dementia were identified in practices, and permission sought from the older person and/or their carer to study the medical records of these patients. Medical records were reviewed using a data extraction tool designed for the study and based on published guidelines, and unweighted scores for diagnostic concordance and management concordance were calculated. Four hundred and fifty records of patients aged 75 and over with a diagnosis of dementia were reviewed and it was found
More action needed to prevent HIV and improve diagnosis
- Author:
- HAIRON Nerys
- Journal article citation:
- Nursing Times, 18.12.07, 2007, pp.21-22.
- Publisher:
- Nursing Times
A new study examining the use of health care services before HIV diagnosis suggests that health care professionals could do much more in order to improve HIV prevention and detection in at-risk groups, including African patients.
The accuracy of family physicians' dementia diagnoses at different stages of dementia: a systematic review
- Authors:
- DUNGEN Pim van den, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(4), April 2012, pp.342-354.
- Publisher:
- Wiley
Accurate recognition and diagnosis of dementia are critical if care is to be optimised. Given the importance of early diagnosis, the authors compared the accuracy of diagnosis of individuals at different stages of dementia in a primary care setting. Data from six cross-sectional studies were extracted from papers retrieved during a search of Pubmed, Embase, CINAHL, PsycINFO and the Cochrane that many individuals with dementia are not recognised or not diagnosed as such; particularly mild dementia. Collaboration and education focussing both on knowledge and attitude are recommended to improve the accuracy of general practitioners’ dementia diagnosis.
Initiatives to shorten duration of untreated psychosis: systematic review
- Authors:
- LLOYD-EVANS Brynmor, et al
- Journal article citation:
- British Journal of Psychiatry, 198(4), April 2011, pp.256-263.
- Publisher:
- Cambridge University Press
Long duration of untreated psychosis (DUP) is associated with poor outcomes for people with first-episode psychosis and with poorer quality of life at first contact with services. However long DUP is common, studies have reported means of over 2 years and medians of up to 26 weeks. Treatment delays can occur before and after someone has initiated help seeking. Strategies to reduce treatment delays are widely advocated. This systematic review looks at the available evidence on the effectiveness of early detection initiatives to reduce the DUP. It includes 11 studies evaluating a total of 8 early detection initiatives. The studies involved both GP education campaigns and multifocus campaigns. The evidence suggests that GP education campaigns and dedicated early intervention services do not by themselves reduce DUP or generate more treated cases. For multifocus initiatives the evidence is mixed. No studies evaluated initiatives targeting young people or professionals from non-health organisations. It appears that intensive, large-scale multi-focus initiatives including general public awareness as well as relevant professionals are the most promising way to enhance the early detection of psychosis. The authors note that these require organisation and resourcing at a regional or national level and suggest that more good-quality studies are needed to address gaps in knowledge.