title: Quality of care provided to people with dementia: utilisation and quality of the annual dementia review in general practice.
abstract: BACKGROUND
  Primary care services are often the main healthcare service for people with dementia; as such, good-quality care at this level is important.
  
  
  OBJECTIVE
  To measure the quality of care provided to people with dementia in general practice using routinely  collected data, and to explore associated patient and practice factors.
  
  
  METHODS
  Observational, cross-sectional review of medical records from general practices (n = 52) in five primary care trusts.
  
  
  METHODS
  A total of 994 people with  dementia were identified from dementia registers. An unweighted quality-of-care score was constructed using information collected in the annual dementia review, together with pharmacological management of cognitive and non-cognitive symptoms. Multilevel modelling was carried out to identify  factors associated with quality-of-care scores.
  
  
  RESULTS
  In total, 599 out of 745 (80%) patients with dementia had received an annual dementia review; however, a social care review or discussion with carers was evident in just 305 (51%) and 367 (61%) of those 599 cases,  respectively. Despite high prevalence of vascular disease, over a quarter (n = 259, 26%) of all patients with dementia were prescribed antipsychotics; only 57% (n = 148) of these had undergone medication review in the previous 6 months. Those with vascular dementia who were registered  with single-handed practices received poorer quality of care than those registered with practices that had more than one GP.
  
  
  CONCLUSIONS
  Although the number of people with dementia with a record of an annual dementia review is high, the quality of these reviews is suboptimal.  The quality score developed in this study could be used as one source of data to identify weaknesses in practice activity that need to be corrected, and so would be of value to commissioners and regulators, as well as practices themselves.
authors.affiliation: Mental Health and Neurodegeneration Research Group, School of Community Based Medicine, University of Manchester, Manchester.
authors.forename: Amanda
authors.initials: A
authors.lastname: Connolly
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
authors.forename: Ella
authors.initials: E
authors.lastname: Gaehl
authors.forename: Stephen
authors.initials: S
authors.lastname: Campbell
authors.forename: Richard
authors.initials: R
authors.lastname: Drake
authors.forename: Julie
authors.initials: J
authors.lastname: Morris
authors.forename: Helen
authors.initials: H
authors.lastname: Martin
authors.forename: Nitin
authors.initials: N
authors.lastname: Purandare
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003704:Dementia / Q000628:therapy*; D003866:Depressive Disorder / Q000175:diagnosis; D017723:Drug Utilization Review; D004739:England; D005260:Female; D058006:General Practice / Q000592:standards*; D006801:Humans; D008297:Male; D011787:Quality of Health Care; D012052:Reimbursement, Incentive