title: Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review.
abstract: BACKGROUND
  Vascular diseases contribute to the causation and progression of clinical dementia.
  
  
  OBJECTIVE
  To 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.
  
  
  METHODS
  Observational, 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Level 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Mental Health and Neurodegeneration Research Group, University of Manchester, Manchester, UK. ajconnolly3@gmail.com
authors.forename: Amanda
authors.initials: A
authors.lastname: Connolly
authors.forename: Stephen
authors.initials: S
authors.lastname: Campbell
authors.forename: Ella
authors.initials: E
authors.lastname: Gaehl
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
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: D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000628:therapy*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000209:etiology*; D004739:England; D005260:Female; D058006:General Practice / Q000592:standards; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011787:Quality of Health Care; D012307:Risk Factors
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