Cut antipsychotics use through QOF, researchers say

Antipsychotic prescribing for dementia should be reviewed as part of the QOF to slash inappropriate use, according to researchers.

A quality-of-care score developed by UK researchers could be used to expand the QOF’s dementia domain to improve the quality of annual medication reviews.

Their study, published in the BJGP, found that 26% of dementia patients were prescribed antipsychotics, despite a high prevalence of vascular disease among patients. The drugs can increase the risk of cardiovascular events such as stroke.

Just 57% had undergone a medication review in the past six months.

It comes after the DH conceded in November last year that it had missed its target to cut antipsychotic prescribing by two thirds within a year.

A University of Manchester team used data from existing QOF dementia indicators to assess GPs' annual reviews for dementia patients – the first study to do so.

They assessed whether GPs had carried out all four components of the annual review, including checking mental health, medication, social care and discussion with carers.

Their findings covered 994 people with dementia from the registers of 52 practices across five PCTs.

They showed that although most patients received an annual review, quality was variable.

Eight in 10 patients had received an annual review, and more than six in 10 had a discussion with carers. But just 51% had a social care review.

Patients were more than twice as likely to have had an annual review at a multi-handed practice than a single-handed one.

Researchers then scored practices by dividing the number of relevant clinical reviews provided by the number for which patients were eligible.

On average, GPs conducted 62% of relevant reviews, though this varied greatly between practices.

Researchers said this scoring system could be used to expand the QOF dementia domain. ‘For example, adding more specific indicators covering management of medication, as well as mental health and social care, for patients with dementia may allow for improved assessment of quality.’

Authors said the score could also pick up weaknesses in practice activity and may be 'valuable' to commissioners and regulators for performance management.

In June, the Dementia Action Alliance (DAA), a group of 50 organisations including the RCGP, the Alzheimer's Society and the government, called on GPs to review patients on antipsychotics by April 2012.

Use of antipsychotics have been linked to pneumonia, weight gain, stroke risk and mortality risk.

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