Charlotte Morris, Roukia Techache, Katie Davies, Tom Blakeman, Evangelos Kontopantelis, Darren M. Ashcroft, Dame Louise Robinson
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It is unclear how the quality and safety of this healthcare varies with socio-economic factors.</p>\n </section>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>This scoping review aimed to understand the depth and breadth of existing evidence exploring socio-economic variation in the quality and safety of primary care for people with dementia.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Prescribing and care planning indicators of high-quality, safe primary care were defined from guidance. Composite and proxy markers of socio-economic status (SES) were defined. EMBASE, MEDLINE, PsychInfo, The Cochrane Database of Systematic Reviews, worldcat.org and clinicaltrial.gov databases were searched. Studies in English, on human participants from 2006 onwards were eligible. Narrative synthesis was conducted. Studies explored how one or more selected indicators (anti-dementia medication and anti-psychotic prescribing, potentially inappropriate prescribing (PIP), medication review, dementia review or care planning) varied with a recognised marker of SES in people with dementia.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Searches identified 1980 studies after removing duplicates. 385 full texts were reviewed, with 53 eligible for inclusion (51 quantitative, 2 reviews). Most identified studies explored prescribing processes (50 quantitative, 2 reviews), with 2 exploring annual review.</p>\n \n <p>There was evidence of substantial disparity in quality and safety indicators in studies exploring prescribing; 20/29 (69%) of studies exploring anti-dementia medication prescribing found those with markers of lower SES were significantly less likely to receive these. 16/28 studies exploring PIP/Anti-psychotics found significant disparities in safe prescribing for those with markers of lower SES. Neither study exploring annual reviews found any significant differences across SES.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>We found evidence of disparity in the quality and safety of post-diagnostic primary care for people with dementia based on SES, particularly for a range of prescribing indicators. Further work exploring inequalities in care planning and reviews for people with dementia is needed to understand existing inequalities in the quality and safety of primary care for people with dementia.</p>\n </section>\n </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"39 12","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666866/pdf/","citationCount":"0","resultStr":"{\"title\":\"Inequalities in the Quality and Safety of Post-Diagnostic Primary Care for People With Dementia: A Scoping Review\",\"authors\":\"Charlotte Morris, Roukia Techache, Katie Davies, Tom Blakeman, Evangelos Kontopantelis, Darren M. 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引用次数: 0
摘要
导言：国际指南为向痴呆症患者提供安全、高质量的初级保健提出了建议，包括处方、个性化护理规划和定期全面审查。目前尚不清楚这种医疗保健的质量和安全性如何随社会经济因素而变化。目的：本综述旨在了解现有证据的深度和广度，探讨痴呆症患者初级保健质量和安全性的社会经济差异。方法：从指南中确定高质量、安全初级保健的处方和护理计划指标。定义了社会经济地位（SES）的综合和代理标记。检索了EMBASE、MEDLINE、PsychInfo、Cochrane Database of Systematic Reviews、worldcat.org和clinicaltrial.gov数据库。从2006年起，对人类参与者进行的英语研究符合条件。进行叙事综合。研究探讨了一个或多个选定的指标（抗痴呆药物和抗精神病药物处方，潜在不适当处方（PIP），药物审查，痴呆审查或护理计划）如何与痴呆症患者公认的SES标记物变化。结果：删除重复项后，检索确定了1980项研究。共审查了385篇全文，其中53篇符合纳入条件（51篇定量分析，2篇综述）。大多数确定的研究探讨了处方过程（50个定量研究，2个综述），2个探讨年度综述。有证据表明，在探索处方的研究中，质量和安全指标存在实质性差异；20/29（69%）的抗痴呆药物处方研究发现，那些社会经济地位较低的人接受这些药物的可能性明显较低。16/28研究探索PIP/抗精神病药物发现显著差异的安全处方那些标记较低的社会经济地位。两项探索年度评估的研究都没有发现SES之间有任何显著差异。结论：我们发现了基于SES的痴呆症患者诊断后初级保健的质量和安全性存在差异的证据，特别是在一系列处方指标方面。需要进一步探索痴呆症患者护理规划和审查中的不平等现象，以了解痴呆症患者初级保健质量和安全方面存在的不平等现象。
Inequalities in the Quality and Safety of Post-Diagnostic Primary Care for People With Dementia: A Scoping Review
Introduction
International guidelines make recommendations for the delivery of safe, high-quality primary care for people with dementia including prescribing, personalised care planning and regular holistic reviews. It is unclear how the quality and safety of this healthcare varies with socio-economic factors.
Objective
This scoping review aimed to understand the depth and breadth of existing evidence exploring socio-economic variation in the quality and safety of primary care for people with dementia.
Methods
Prescribing and care planning indicators of high-quality, safe primary care were defined from guidance. Composite and proxy markers of socio-economic status (SES) were defined. EMBASE, MEDLINE, PsychInfo, The Cochrane Database of Systematic Reviews, worldcat.org and clinicaltrial.gov databases were searched. Studies in English, on human participants from 2006 onwards were eligible. Narrative synthesis was conducted. Studies explored how one or more selected indicators (anti-dementia medication and anti-psychotic prescribing, potentially inappropriate prescribing (PIP), medication review, dementia review or care planning) varied with a recognised marker of SES in people with dementia.
Results
Searches identified 1980 studies after removing duplicates. 385 full texts were reviewed, with 53 eligible for inclusion (51 quantitative, 2 reviews). Most identified studies explored prescribing processes (50 quantitative, 2 reviews), with 2 exploring annual review.
There was evidence of substantial disparity in quality and safety indicators in studies exploring prescribing; 20/29 (69%) of studies exploring anti-dementia medication prescribing found those with markers of lower SES were significantly less likely to receive these. 16/28 studies exploring PIP/Anti-psychotics found significant disparities in safe prescribing for those with markers of lower SES. Neither study exploring annual reviews found any significant differences across SES.
Conclusion
We found evidence of disparity in the quality and safety of post-diagnostic primary care for people with dementia based on SES, particularly for a range of prescribing indicators. Further work exploring inequalities in care planning and reviews for people with dementia is needed to understand existing inequalities in the quality and safety of primary care for people with dementia.
期刊介绍：
The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers.
The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.
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