dementia master class dr helen martin dr harry allen
TRANSCRIPT
Dementia Master ClassIntroductions
Objectives for LES/DES and Masterclass
Why has dementia become such an important issue?
How do we do in Manchester?
What are the opportunities?
Order of play for today
Objectives for LES and DES
DES: national case finding: Asking those who are at risk if they would like memory review
LES: for those with established diagnosis in Central Manchester
LES: Highlight the potential gaps in care and tailor an approach so your practice can bridge them
Use masterclass and patient review document to support this
Objectives Master ClassConsider our own practice with the help of
learning needs assessment: identify gaps in care
Use peer discussion and expert workshops to help generate a realistic action plan for your practice to improve the care of patients with dementia.
Develop knowledge of clinical and legal issues so you can be a resource in your practice
Consider the needs of your patients for future master class and commissioning decisions
Dementia Master ClassIntroductions
Objectives for LES/DES and Masterclass
Why has dementia become such an important issue?
What are the opportunities? How do we do in Manchester?
Order of play for today
Importance: demographicsand economics
1/20 of older people has dementia
Prevalence 1.3%
Central Manchester estimated prevalence 1167
Diagnosed 525
BAME prevalence rising faster (7-fold in 40y)
£19 billion in England
25% of hospital beds
2/3 of people living in care homes
Importance: National Dementia Strategy
Improve knowledge and reduce fear and stigma
Earlier diagnosis: information support and care
Equal and high quality of care
Diagnosis GapThere is a gap…why?
Central Manchester 525/1167= 48%
National Dementia Challenge: Increase diagnosis rate to 66% by 2015
Why? Lack of confidence in what can we offer patients
Opportunities: earlier and timely diagnosis
Diagnosis: gateway to making informed choices
‘I would want to know so I can plan ahead’
Advanced care planning
‘It was too late to get power of attorney by the time diagnosis was given, which caused problems and financial hardship as we were unable to access Dad’s savings account when he needed a ramp to get outside, and had to use a credit card for expenses which obviously cost more.’
Opportunities: Carer Support
550,000 carers in England
£7billion unpaid care
In one study of substantial carers, over half the sample said they were in good health, but General Health Questionnaires (GHQs) indicated that 94% could be identified as having psychiatric disorders;
Problems associated with carer was a contributing factor in 62% of readmissions
Support for carers reduces hospital and residential care admissions
Opportunities: vascular risk factors
Up to 50% have a vascular component
20% have predominantly vascular aetiology
BJGP: inequalities in 22/30 QoF measures
Evidence for intervention?
NICE guidelines, King’s college review due
Losartan and ACE inhibitors
HyVet study showed that the benefits of treating hypertension in terms of reduced mortality and stroke were evident at 12months
Opportunities: co-morbidities
Painful Osteoarthritis prevalence is 1/5 (50-59)
1/2 of those aged over 80y
BMJ 2011: treating agitation with analgesics resulted in significant improvement, regular NOT prn
Vision
Hearing
Dental health
Opportunities: anticipation of problems and risk
Hospital admission reduction
Care package can be increased
Predictable outcomes with intercurrent illness
Better hospital care if identified
Summary of Importance & Opportunities
Common
Established dementia often not diagnosed.
Earlier diagnosis and high quality care are national priorities
Benefits in planning ahead are important
Lots of clinical gain for patients and families if we take a comprehensive view of care.
Today2.00 Helen Martin
2.15 Learning Needs Assessment: peer discussion
2.40 Workshop 1
3.10 Workshop 2
3.40 Break
3.50 Workshop 3
4.20 Action Plans: small groups
4.45 What’s Next
Learning Needs Assessment
Diagnosis
Carers
Building
Non clinical staff
Comprehensive management including end of life
Management of challenging behaviour
What are your priorities??
Action PlanQualitative review of patients with behaviour
that challenges
How will you prioritize?
How will you implement?
SMART
SummaryWe only know about half of our patients
We have a lot to offer
Secondary prevention
Supporting carers
Maintaining independence
Reducing admissions
Planning ahead
What next?Practices will:
Facilitate a multi disciplinary team meeting identifying key areas for improvement
Audit the quality of Dementia Care using Patient Review Template as a guide
Undertake a Qualitative review of 5 dementia patients with BPSD
Formulate and implement practice Action Plan
Contribute to the agenda for next Master Class
Undertake the 1st of two Dementia Patient Reviews