Dementia initiative to reduce inappropriate GP use of antipsychotics

A call to action is inspiring stakeholders including GPs to commit to change an intolerable situation, writes Nadia Chambers, lead associate, NHS Institute for Innovation and Improvement, Chris Quince, senior policy officer, Alzheimer's Society, Jonathan Mason, clinical adviser (Medicines) NHS North East London and the City and Rachel Thompson, Dementia Project Lead, Royal College of Nursing.

Digital channels are helping GPs to learn more about dementia to improve their practice
Digital channels are helping GPs to learn more about dementia to improve their practice

Good quality dementia care is about ensuring people are able to live the best quality life possible, whatever stage of the condition they are at. Yet unfortunately this isn’t always the reality. In an effort to change this picture, the NHS Institute for Innovation and Improvement has been working as part of the Dementia Action Alliance (DAA) – an association of over 70 organisations – to take forward a ground–breaking approach to improving care for people with dementia and supporting the reduction in the use of inappropriate and costly medicines.


Last June, the Alliance launched a call to action - The Right Prescription - which aims to encourage and empower healthcare professionals to commit to review and, where possible, reduce the inappropriate use of antipsychotic drugs. Currently one in five of the 800,000 people with dementia in the UK are prescribed these drugs, but in two thirds of cases their prescription is inappropriate.


Antipsychotics can lead to serious health problems and even death. They can increase dementia symptoms and lead to sedation, dehydration and increased risk of stroke, as well as dizziness and unsteadiness that can result in falls and injuries. In fact, it is estimated that five people with dementia die needlessly every day in England as a result of taking antipsychotic drugs and four suffer significant avoidable complications. Prescriptions of antipsychotics also have a huge economic cost. It is estimated that in England alone, £80m is spent on them each year. In contrast, recent NHS calculations show that use of behavioural interventions could bring about £70.4 million in healthcare savings derived from a reduction in strokes and falls.


With numbers of people living with dementia set to rise to over a million by 2021, it is vital that the situation changes. Now many clinicians are taking action.


The call to action is bringing much needed change by engaging with a wide range of health professionals involved in the care of people with dementia - from GPs, pharmacists and hospital doctors to psychiatrists, multi-disciplinary health teams and care home managers. It aims to raise their awareness of the intolerable consequences of inappropriate antipsychotic drug prescriptions and to secure their commitment to making changes in their local area.


Part of this is being achieved through guides produced by the Alzheimer’s Society for carers and health and social care professionals on the management of behavioural and psychological symptoms of dementia. Nurses working in a range of settings including hospitals and care homes are reviewing the use of antipsychotic medication and training staff to use alternative approaches in response to distressed behaviour. As well as this, a great deal of work is being conducted via digital channels, which are playing a huge role in helping GPs and other healthcare professionals to learn more about dementia and improve their practice. For example, around 1,000 people are active on the call to action online community and each one works with a wider team. Online seminars offering free information and advice have attracted up to 500 participants per session.


The DAA has also connected with more than 25,000 senior nursing leaders via a monthly bulletin and its junior doctors’ induction pack has been used by more than 100 acute trusts. Furthermore, the call to action team has presented this work in support of the dementia commissioning guidelines to 2,000 people and is working with four leading care home providers.


DAA Call to Action’s work with the Royal Pharmaceutical Society will see 42,000 community pharmacists receive resources to help them to become drivers for change in dementia treatment, particularly in care homes, where they often work alongside GPs.


Everyone who is part of the DAA Call to Action has played a key role in ensuring that around 80% of people who have been diagnosed with dementia and who are prescribed antipsychotics in England have had a clinical review to consider alternative interventions.


Between now and December, the DAA Call to Action will focus on the remaining 20% of people who have been diagnosed with dementia but have not been reviewed.


There is still work to be done, as currently only 43% of people with dementia ever receive a diagnosis. This means there are likely to be many other people with dementia without a diagnosis who are also being prescribed antipsychotics. It is imperative that we continue to work with healthcare professionals to help raise diagnosis levels.


The Call to Action and the work going on around it will continue to transform the lives of people with dementia by helping healthcare professionals to fully understand their plight and by inspiring them to commit to implementing the radical changes needed to provide the highest quality, cost effective care now and in the future.





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