Date post: | 19-Feb-2017 |
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Should Dementia be Diagnosed and Treated in
Primary or Secondary Care?
Dr Patricia DonaldGP in NW Edinburgh
General Practice
GP Practice: •GPs•Practice Manager•Practice Nurse Team•Receptionists•Secretaries
Lothian Audit 2011 confirmed that 90% of patient contacts with general practice were managed within Primary care and not referred to Secondary Care.
Multidisciplinary health care taking place outside Secondary/Tertiary Care providing care for the individual in the community
PRIMARY
CARE
GP Practices
Community nursing
Allied Health
Professionals
Optometrists
Community
PharmacyCommunity Mental
Health
Out of Hours
Services
Dentists
Third Sector
Social Care
“Diagnosis of Dementia”
Early awareness by many……..Individual, Partner, Family, Friends, Carer, Community, Pharmacist, Receptionist
Initial discussion with GP
Further assessment of memory and physical health
Referral to Secondary care if appropriate
12
34
GP making the diagnosis
• Lack of competence: requires training
• Lack of confidence• Lack of time• Lack of access to diagnostics• Lack of Post Diagnostic
support• Requires transfer of
resources with this transfer of work
• Why is this question being asked? Who will benefit?
Workload in General Practice
• GP Workforce crisis:• one third of practices in Lothian are closed
or have restricted lists • 21 GP Partner vacancies in Edinburgh
• End of QOF• New GP Contract 2017• Integrated Joint Boards• Funding allocation
“Treatment of Dementia”
• Medical treatment for Dementia started in Secondary Care and continued in Primary Care
• Other medication for mental or physical co-morbidities
• Ongoing monitoring • Stopping some medication is important
too!
“Treatment versus Management”
Treatment• Medical treatment for
Dementia started in Secondary Care and continued in Primary Care
• Other medication for mental or physical co-morbidities
• Ongoing monitoring • Stopping some
medication is important too!
Management Person Centered Care Encourage Self
management Community support Carer support
Aim: to lead as normal a life as possible in their own home.
Beware of ‘medicalisation’ of dementia care!
GP Practice ongoing roleMedication monitoringPhysical and Mental health reviewsMaintain accurate and up to date patient
record for continuity of careKIS for shared informationLinks with Post Diagnostic supportSignposting to community assetsSignposting to 8 Pillar support
Other issues to address
• Waiting Times for Secondary Care Diagnosis• Communication between Secondary and Primary
Care• Post Diagnostic Support Capacity• Shared information• Old age Psychiatry/CPNs capacity and in-patient
beds• Integration of Care of the Elderly with Psychiatry• Transferring diagnosis from Secondary to Primary
Care provides no benefit to the patient and would result in patchy and insufficient provision of services