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New knowledge

Inequalities in access to good quality care in dementia in the United Kingdom

Purpose

This study aimed to investigate whether there is socioeconomic inequality in the mental and physical health care received by people with dementia in the UK. We defined high quality dementia healthcare in this study as: access to cholinesterase inhibitors to treat dementia symptoms where they are indicated (known sometimes as ‘anti-dementia’ drugs); access to primary care and preventative health care; and low rates of antipsychotic, hypnotic, and anxiolytic medication use, as these should be prescribed with caution due to the associated risks of cognitive decline and death.

Timescale

2014 – 2016

Research team

Jill Manthorpe (SCWRU), Claudia Cooper, Kate Walters, Rebecca Lodwick, Steve Iliffe (UCL)

Funding

Dunhill Medical Trust

Methods

The Health Improvement Network (THIN) is a large database of anonymised electronic medical records. It is regularly updated and currently contains data on 11 million patients (about 20,000 of whom have dementia), and is the largest epidemiological dataset of people with dementia in the UK. We compared the overall rates of prescribing cholinesterase inhibitors over time using the THIN dataset (cholinesterase inhibitors are only currently prescribed for treatment of Alzheimer’s disease). We focused on only those patients with a diagnosis of dementia and compared the characteristics of those prescribed a cholinesterase inhibitor and those not in terms of gender, age, time-period, country (England, Northern Ireland, Scotland and Wales), region (England), rural or urban area, and by level of deprivation (quintiles of deprivation). Other outcome measures were analysed.

Outputs

The study published its initial findings in 2016 and an article has been published.

Impact

The study findings were widely reported in the news media (The Sun, The Guardian, The Daily Telegraph, Morning Star) and by care home and pharmaceutical companies; they will inform clinical and policy communities.

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