How does diagnostic subtype affect the quality of primary care for people with dementia? A retrospective cohort study in 1490 English general practices.
Introduction Diagnostic subtype has been suggested as a determinant of inequity for people with dementia; its impact on primary care provision is underexplored. This study investigated the association between dementia subtype and likelihood of receiving guideline-consistent primary care. Method Retr...
| Publicado en: | Age & Ageing Vol. 55; no. 4; pp. 1 - 11 |
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| Autores principales: | , , , , , |
| Formato: | Artículo |
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Oxford University Press / USA
Apr2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=193500096&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 193500096 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Apr2026 vid: 55 iid: 4 pid: 622 pub: Oxford University Press / USA artinfo: ui: 193500096 10.1093/ageing/afag101 ppf: 1 ppct: 10 formats: tig: atl: How does diagnostic subtype affect the quality of primary care for people with dementia? A retrospective cohort study in 1490 English general practices. aug: au: Morris, Charlotte Mok, Pearl L H Robinson, Dame Louise Ashcroft, Darren M Blakeman, Tom Kontopantelis, Evangelos affil: Division of Population Health, Health Services Research and Primary Care School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UKNIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, M13 9PL, UKNIHR School for Primary Care Research, The University of Manchester, Manchester, M13 9PL, UK NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, M13 9PL, UKDivision of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, England, M13 9PL, UK Population Health Science Institute, Faculty of Medical Science, University of Newcastle upon Tyne, Newcastle upon Tyne, NE1 7RU, UK Population Health Science Institute, Faculty of Medical Science, University of Newcastle upon Tyne, Newcastle upon Tyne, NE1 7RU, UKNIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, England, M13 9PL, UKNIHR School for Primary Care Research, The University of Manchester, Manchester, England, M13 9PL, UK Division of informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UKDivision of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore su: United Kingdom Medical quality control Primary health care Retrospective studies Patient care Health equity Treatment of dementia Medical protocols Inappropriate prescribing (Medicine) Parasympathomimetic agents Research funding Alzheimer's disease Lewy body dementia Questionnaires Descriptive statistics Medication error prevention Odds ratio Medical records Acquisition of data Dementia Data analysis software Confidence intervals Dementia patients sug: subj: Medical quality control Primary health care Retrospective studies Patient care Health equity United Kingdom Treatment of dementia Medical protocols Inappropriate prescribing (Medicine) Parasympathomimetic agents Research funding Alzheimer's disease Lewy body dementia Questionnaires Descriptive statistics Medication error prevention Odds ratio Medical records Acquisition of data Dementia Data analysis software Confidence intervals Dementia patients keyword: care plan copyrightHolder:British Geriatrics Society copyrightYear:2026 dementia dementia subtypes diagnosis health disparity health inequity https://dx.doi.org/10.1093/ageing/afag101 inLanguage:en medication review older people prescribing primary care primary health care publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/42003348/ care plan copyrightHolder:British Geriatrics Society copyrightYear:2026 dementia dementia subtypes diagnosis health disparity health inequity https://dx.doi.org/10.1093/ageing/afag101 inLanguage:en medication review older people prescribing primary care primary health care publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/42003348/ ab: Introduction Diagnostic subtype has been suggested as a determinant of inequity for people with dementia; its impact on primary care provision is underexplored. This study investigated the association between dementia subtype and likelihood of receiving guideline-consistent primary care. Method Retrospective cohort study using Clinical Practice Research Datalink (Aurum) database, 1.1.2006-30.06.2024. We examined potential inequity with eight dementia subtypes: Alzheimer's disease (AD), Lewy body dementia (LBD), vascular, frontotemporal, unspecified, other and two mixed categories. Six outcomes were examined: care plan or medication review (both within 24 months of index) and four indicators of potentially inappropriate prescribing (PIP) (high anti-cholinergic burden drugs, z-drugs, benzodiazepines and anti-psychotics). Cox-regression models were used, adjusting for: age, sex, comorbidities, deprivation and ethnicity. Results A total of 571 663 people were included and 72.1% received a care plan; 79.4% received a medication review within 24 months. Compared to AD: people with mixed dementias were more likely to receive a care plan [hazard ratio (HR) 1.29, 95% confidence interval (CI) 1.26–1.32 for mixed including AD/LBD, HR 1.37, 1.32–1.43 for mixed non-AD/LBD]. All other subtypes were less likely to receive a care plan. Individuals with mixed AD/LBD (HR 1.28, 1.26–1.32), mixed non-AD/LBD (HR 1.35, 1.26–1.45), vascular (HR 1.05, CI 1.04–1.07), LBD (HR 1.02, 1.01–1.04) and unspecified (HR 1.02, 1.01–1.03) were more likely to receive medication reviews. Compared to AD, all other subtypes were more likely to experience PIP across all four indicators. Conclusion We found greater likelihood of PIP in people with non-AD dementias, a novel finding. Further research is needed, especially with new AD drugs potentially widening disparities. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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