DoH axed dementia diagnosis plan

Details of quality framework expert panel views reveal backing for more dementia tests.

GPs could struggle to identify treatable cases of dementia after a number of new quality framework indicators were rejected by the DoH.

The National Primary Care Research and Development Centre (NPCRDC) have released details of all the recommendations made by the expert panels for clinical changes to the 2008/9 quality framework.

Only a small number of recommended changes were made to the framework, including adding proteinuria tests to the chronic kidney disease domain.

Recommendations to expand the dementia domain were not taken forward despite a recent National Audit Office survey showing that just 31 per cent of GPs had received basic and post-qualifying training to diagnose and manage dementia.

The expert panel recommended that GPs look for potential reversible causes of dementia. GPs would be incentivised to check full blood count and erythrocyte sedimentation rate, thyroid function, vitamin B12 and folate levels within four weeks of diagnosis.

Blood tests for urea, electrolytes, calcium, glucose and liver function were also included.

Currently, GPs are awarded 20 quality points for registering and reviewing patients with dementia.

Dr Roger Bullock, clinical director of older people services at Avon and Wiltshire Mental Healthcare Partnership Trust, said it was 'a shame and a strange decision' not to include the tests in the quality framework.

'It is important not to label people with dementia and these are first line tests that are vital for diagnosis of reversible dementia,' he said.

'People with low thyroid levels can behave like they are in the early stages of dementia.'

The expert panel also backed proposals for GPs produce a register of patients with fractures and record results of dual X-ray absorptiometry scans as part of an osteoporosis domain.

Points for a register of peripheral arterial disease (PAD) and records of BP and cholesterol in these patients, and use of aspirin, anti-platelet therapy or an anti-coagulant also featured.

Both osteoporosis and PAD are part of a clinical directed enhanced service that is still to be negotiated.

NPCRDC quality framework evidence-based reports 2008

Proposed indicators

  • Record urea and electroylytes, calcium, glucose, and liver function.
  • Record thyroid function.
  • Record vitamin B12 and folate levels.

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