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Referral patterns and acetylcholinesterase inhibitor prescribing for cognitive impairment (1999-2007): impact of NICE guidelines

^*The Ladywell Unit, Lewisham High Street, South London and Maudsley NHS Foundation Trust, London SE13 6LW, email: yogesh34{at}hotmail.com

Claudia Cooper, Research Training Fellow

University College London, Department of Mental Health Sciences

Gill Livingston, Professor of Psychiatry of Older People

University College London, Department of Mental Health Sciences

Declaration of interest

None.

AIMS AND METHOD

We hypothesised that the proportion of people referred to two outer London mental healthcare services for older people with cognitive impairment increased after the 2001 National Institute for Health and Clinical Excellence (NICE) guidelines for acetylcholinesterase (AChE) inhibitor use in Alzheimer’s disease, but declined after the amended 2006 guidelines. We reviewed case notes for 546 individuals referred between 1999 and 2007.

RESULTS

The proportion of individuals with cognitive impairment referred increased between 1999 (56.1%) and 2005 (70.5%, ²=5.4, P=0.02), as did the proportion prescribed AChE inhibitor (0.8% to 16.1%, ²=27.5, P<0.001). There were no significant changes between 2005 and 2007.

CLINICAL IMPLICATIONS

The 2006 NICE amendment may have curbed the increase in psychiatric referrals and AChE inhibitor prescribing rates for people with cognitive impairment but so far these rates have not decreased.

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