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Original papers: Christopher O’Loughlin and Jon Darley Has the referral of older adults with dementia changed since the availability of acetylcholinesterase inhibitors and the NICE guidelines? Psychiatr Bull 2006; 30: 131-134 [Abstract] [Full text] [PDF]

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IMPACT OF NICE GUIDELINES on Memory Clinic Referrals has already been Studied

Dr. Zaffar Ul Hassan   (20 April 2006)

IMPACT OF NICE GUIDELINES on Memory Clinic Referrals has already been Studied 20 April 2006
Dr. Zaffar Ul Hassan, STAFF GRADE Psychiatrist, Wakefield Memory Service Fieldhead Hospital, Wakefield,West Yorkshire Send letter to journal: Re: IMPACT OF NICE GUIDELINES on Memory Clinic Referrals has already been Studied zaffarul_hassan{at}yahoo.co.uk Dr. Zaffar Ul Hassan	O'Loughlin and Jon (Psychiatric Bulletin, April 2006 30, 131-134) have claimed that their study is the first to examine the changing pattern of referrals after the release of NICE guidelines in 2001. I would like to correct their assumption as while I was completing my Masters qualification from Kings College, London, the dissertation about The audit of waiting time of the memory clinic (Hassan, 2002) at Fieldhead Hospital, Wakefield, I covered the same areas of investigation. It was presented in the local audit meeting, distributed to neighbouring hospital libraries and referenced in another study (Timlin, A et al-2005). We studied the rate of referrals for a period of 6 months between 1st October 2001 and 31st March 2002. 130 patients were booked for the first assessment giving an average referral rate of 5 patients per week. A postal questionnaire was sent out to the local General Practitioners(GP’s) who had referred their patients for an assessment and possible treatment with an anti-dementia medication. One of the questions asked in the survey was that, since its press coverage following the release of NICE guidelines, have you experienced more carer requests to prescribe these medications? In our audit, overall GP’s response rate was 63%. Surprisingly, out of these only 30% answered Yes and 70% No. When we compared this answer with the rate of referrals received at our end, it showed that there was no set pattern of increase or decrease in referrals. In our hospital-based clinic, the waiting time between the GP’s referral and first assessment was approximately 8 to 12 weeks. We also asked them to comment on the possible increase of waiting time. One of the GP’s comments was that we are only referring the tip of iceberg and another commented that we are aware that the waiting list is a problem; if we referred all suitable patients you could not cope. One important comment was that if the waiting time increased anymore, he would not refer any more. This last comment had reflected an earlier finding by Startup (1994) that referring agents often stop requesting for services after acknowledging that a waiting list exists (Riordan and Mockler-1997). One of the suggestions we received was to train and support the GP’s with special interest in Dementia. As pointed out by Connolly and Bullock (2003) in their study, there was some concern about the difficulty of identifying patients with mild disease and one may argue that in our study it could be one of the reasons for not experiencing a huge rise in referral requests. References: O'Loughlin, Christopher, Darley, Jon (2006) Has the referral of older adults with dementia changed since the availability of acetylcholinesterase inhibitors and the NICE guidelines? Psychiatric Bulletin 30: 131-134 Hassan, Z U (2002) An Audit of Waiting Time for a Memory Clinic, Master’s Dissertation, Kings College, London Timlin, A et al (2005) Memory Matters: A report exploring issues around the delivery of anti dementia medication, The Ageing and Mental Health Research Group, The University of Huddersfield. ISBN 186218. Available from http://www.hud.ac.uk/hhs/research/amh/amhrg0105.pdf (accessed on 06/04.2006) Connolly and Bullock (2003) Treatment of patients with Alzheimer’s disease: a national survey following release of the of the NICE guidance, Psychiatric Bulletin, 27, 11-13 Riordan, J and Mockler, D(1997) Clinical Audit in Mental Health, Towards a Multidisciplinary Approach. John Wiley & Sons, Chichester,U.K