Can psychiatric liaison reduce neuroleptic use and reduce health service utilization for dementia patients residing in care facilities.
BACKGROUND
The quality of care and overuse of neuroleptic medication in care environments are major issues in the care of elderly people with dementia.


METHODS
The quality of care (Dementia Care Mapping), the severity of Behavioural and Psychological Symptoms (BPSD--Neuropsychiatric Inventory), expressive language skills (Sheffield Acquired Language Disorder scale), service utilization and use of neuroleptic drugs was compared over 9 months between six care facilities receiving a psychiatric liaison service and three facilities receiving the usual clinical support, using a single blind design.


RESULTS
There was a significant reduction in neuroleptic usage in the facilities receiving the liaison service (McNemar test p<0.0001), but not amongst those receiving standard clinical support (McNemar test p=0.07). There were also significantly less GP contacts (t=3.9 p=0.0001) for residents in the facilities receiving the liaison service, and a three fold reduction in psychiatric in-patient bed usage (Bed days per person 0.6 vs. 1.5). Residents in care facilities receiving the liaison service experienced significantly less deterioration in expressive language skills (t=2.2 p=0.03), but there were no significant differences in BPSD or wellbeing.


CONCLUSIONS
A resource efficient psychiatric liaison service can reduce neuroleptic drug use and reduce some aspects of health service utilization; but a more extensive intervention is probably required to improve the overall quality of care.
Ballard
Clive
C
Newcastle General Hospital, Newcastle, UK. c.g.ballard@ncl.ac.uk
Powell
Ian
I
James
Ian
I
Reichelt
Katharina
K
Myint
Pat
P
Potkins
Dawn
D
Bannister
Carol
C
Lana
Marisa
M
Howard
Robert
R
O'Brien
John
J
Swann
Alan
A
Robinson
Damian
D
Shrimanker
Jay
J
Barber
Robert
R
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010348:Patient Care Team; D011320:Primary Health Care / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation
D014150:Antipsychotic Agents