Dementia – the truth comes out due to focus on prevalence rather than incidence. The ethics need further discussion.

The government’s short termism in encouraging diagnosis of dementia for a short period of time has exposed the hidden problem. Patients do not often present with dementia: rather with memory loss or behaviour disturbance. They may be driving, or holding down a job in a charity or on a committee. Brutally telling the truth is not in most GP lexicons, so perhaps patients some were not aware of an early diagnosis, but NHSreality expects most were. The virtues conflicting are truth telling (veracity) and doing no harm (maleficence). The risk of psychological harm from an early diagnosis when someone is generally capable is significant… The ethical concerns are real. Dementia may progress but it may stay stationary for years..

In a 10 minute consultation with an elderly person there is hardly time to do a good job. When Chris Smyth reports 20th January 2016 in The Times: Dementia diagnoses soared after GPs given £55 ‘bribes’ , he is passing a value judgement and winding up an already annoyed profession. This was a short term inducement to find out the prevalence of dementia. it was information the government needed to predict its future social care budget! It is good to know prevalence as well as incidence of problematic new cases. (Incidence should not be confused with prevalence, which is the proportion of cases in the population at a given time rather than rate of occurrence of new cases. Thus, incidence conveys information about the risk of contracting the disease, whereas prevalence indicates how widespread the disease is.)

Dementia diagnoses jumped during a six-month campaign when GPs were offered “bribes” of £55 to record the condition.

A political push to tell more people that they had dementia led to a spike in diagnoses that tailed off after the NHS “took its eye off the ball”, figures showed.

Charities said the data suggested that the focus on dementia had an impact but that more needed to be done to ensure that people who had dementia diagnosed got the care they needed.

The same figures also showed that dementia was routinely missed in hospitals, with doctors recording it only half the time when people known to have the condition were admitted.

David Cameron pledged in 2012 to give more people with dementia a diagnosis so that they could get better care. Figures published yesterday by the Health and Social Care Information Centre showed that use of dementia drugs increased sixfold in a decade, which experts said was a sign that people were getting an earlier diagnosis, when medication could be of most use.

However, the diagnosis drive faced a backlash when NHS England began paying GPs £55 for every case they found, which was described as an ethical travesty by Iona Heath, the former president of the Royal College of GPs. Many doctors said that the “cash for diagnoses” plan crossed a dangerous line and could undermine patient trust.

Yesterday’s report reveals that diagnosis rates jumped by a fifth during the time the scheme was in operation. Recorded rates of dementia were broadly flat until September 2014 at about 644 cases per 100,000 people. The payments began in October 2014 and ended in April 2015, by which time the rate was 759 per 100,000. It then plateaued and was 755 last month.

George McNamara, the head of policy at the Alzheimer’s Society, said: “What it shows is that an unprecedented focus on dementia diagnosis worked. Post-March the system took its eye off the ball.”

He said that this was because the prime ministerial drive ended and added: “No GP told me that the incentive of £55 meant they started to increase identification of people with dementia. At the same time, we had quite significant pressure within the NHS and politically to make diagnoses.”

Hospital care was “still not good enough” in many places, he added, as figures showed that dementia was not recorded half the time when patients were admitted. “[This is] a simple point that could so easily be addressed to ensure that people with dementia get the specialist care they desperately need,” Mr McNamara said.

Richard Vautrey, the deputy chairman of the British Medical Association’s GPs committee, said that while the payments might have meant that recording a diagnosis had “risen to the top of the to-do list” for some GPs, treatment of patients had not changed. He said initiatives such as case-finding in nursing homes probably had a bigger impact, adding: “There was a whole host of things going on and in many ways the scheme for GPs was the least of them. It was such a political priority.”

Kat Lay counters by reporting 21st Jan 2016: Patient records could help predict risk of developing dementia

Doctors can predict your risk of developing dementia by piecing together hidden clues contained in your medical records, researchers have said.

Crunching information routinely gathered during visits to the family doctor — such as the level of alcohol consumption, whether someone is underweight or if they have a history of depression — can pinpoint which patients are likely to have conditions such as Alzheimer’s disease in the next five years.

A new screening test for people aged 60 to 79 developed at University College London could be used to reassure patients who approach their GPs concerned that they might be developing dementia, the researchers said.

The computer algorithm was developed and tested using the patient records of almost 1 million individuals with no record of dementia, cognitive impairment or memory problems….

Dr Walters said: “This is a much more rigorous way than just picking up individual risk factors.” However, she added: “We are hesitant to say it should be used in this way. There are a lot of ethical questions to be worked out first.”

Screening for dementia can be controversial, with many people preferring not to know their risk, particularly as there is no known cure for the condition. Dr Walters said that she would want to know because studies had shown that there were things patients could do to decrease their risk and new drugs were being developed all the time.

The anonymous records used to develop the dementia risk score tool came from 377 UK general practices and were recorded between 1995 and 2011 in the health improvement network database.

Government plans to make such data more available to researchers, under a scheme known as care.data, have stalled over patient privacy concerns….

 

 

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This entry was posted in A Personal View, Good News, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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