Achieving quality of care in dementia by appropriate and timely diagnosisBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3199 (Published 14 May 2014) Cite this as: BMJ 2014;348:g3199
- Alistair Burns, national clinical director for dementia and professor of old age psychiatry1,
- Jeremy Hughes, chief executive officer2,
- Jill Rasmussen, Royal College of General Practitioners clinical champion dementia3
- 1Core Technology Facility, NHS England and University of Manchester, University of Manchester, Manchester M13 9NT, UK
- 2Alzheimer’s Society, London, UK
- 3Dorking, UK
Brunet thinks that current interest in dementia will lead to harm and overdiagnosis.1 This current awareness is a triumph for a concerted approach from patients, carers, the public, professionals, charities, policy makers, and politicians. There is great dissatisfaction with existing services, especially regarding delays in diagnosis and support immediately after diagnosis and throughout the illness. People involved in dementia practice and policy want to improve this situation so that patients with dementia, families, and carers feel supported at every stage of the illness.
Barely half of those with dementia have a diagnosis, so talk of overdiagnosis is surprising. It does a disservice to the estimated 300 000 people with dementia who, because of that lack of diagnosis, cannot access the support they need. Recognition of dementia enables support to be put in place and may prevent avoidable admission to hospital, longer stays, and admission to care in a crisis.
The diagnosis of dementia can sometimes be a challenge and all thoughtful clinicians would accept that occasionally they make an inaccurate diagnosis of dementia or its subtype. The solution to this problem is to improve education and the interface between primary and secondary care.
Incentives are not compulsory but do deliver investment for extra work. Primary care is under great pressure, so it is not unreasonable to provide a financial incentive if additional work is being done.
The debate around dementia is important and we look forward to a continued dialogue with colleagues of varied viewpoints, but we owe people with dementia and their carers a better quality of care. This can be achieved only by appropriate and timely diagnosis.
Cite this as: BMJ 2014;348:g3199
Competing interests: AB: adviser on dementia to NHS England; editor of the International Journal for Geriatric Psychiatry; received contribution towards travel expenses for the launch of Betrinac; received an honorarium from Healthcare Education Services for being on the teaching team of a course on Alzheimer’s disease; is chair of the Data Monitoring and Ethics Committee for Pimavanserin study in AD Psychosis at King’s College London. JR: NHS: East Surrey CCG commissioning lead for mental health, learning disability and dementia; Strategic Clinical Network SE Coast dementia lead; and co-developer of MoodHive (Depression Anxiety Pathway); Royal College of General Practitioners: chair of Learning Disability Special Interest Group and clinical champion for dementia; consultancy/advisory boards/speakers’ bureau: AstraZeneca, Alzheimer’s Society, Chronos, Lilly, Lundbeck, MGP, Napp, Neuro360, Otsuka, Pfizer, Roche, Servier, Targacept, and TauRX.
Full response at: www.bmj.com/content/348/bmj.g2224/rr/694634.