Service Case Study: Avon LPC publish outcomes from dementia project (May 2015)

Avon LPC has published the outcomes from their Pinnacle Health Partnership funded dementia project. Avon LPC were the successful winners of the £5,000 grant which Pinnacle offered in 2013 aimed at encouraging LPCs to think about dementia and how community pharmacy could play a bigger role  in the care, support and early diagnosis of patients with dementia.

The successful Avon service aimed to make pharmacies more dementia aware, to improve early identification of dementia through pharmacy interventions as well as optimising treatment for patients with dementia by reviewing their medicines.

The project was a three tiered service, which included an initial assessment using the CQUIN question, a Mini-Cog test and a medicines review. A follow-up assessment was also conducted 4-8 weeks later.

In total 180 patients registered to participate in the dementia identification service. Of these, 169 participated in the tier 1 service with 150 (89%) patients saying their memory had affected their lifestyle over the last 12 months. Of these 150 patients, 123 (82%) had not previously spoken to their GP about their memory loss.

The tier 2 service (Mini-Cog test) was offered to 152 patients with 27 (18%) patients scoring positively for dementia. Of these 27 patients, 17 (63%) were already concerned about their memory but had not spoken to their GP about the memory.

The tier 3 service (review of medicines) was offered to 31 patients with 75 medicines being reviewed. Thirteen patients were followed up to review the benefits with 12 (92%) patients saying they benefited from the review.

Extended benefits of the service also included creating over 150 dementia friends, raised awareness of dementia in over 70 pharmacies in Avon and their communities, as well as the development of closer links to support organisations such as Alzheimer’s Society and Carers Trust.

Service documents, including the full service outcomes report are available to view on the Services Database.

Background

In 2013, Pinnacle Health Partnership, in association with Community Pharmacy England, invited all LPCs to take the opportunity to ‘tender’ for a grant of £5,000 and a licence for PharmOutcomes to provide services around dementia for a period of three months or more and gather evidence of the outcomes of that work.

LPCs were required to describe the service that they would develop and the outcomes they would be able to capture. The service was required to maximise the positive impact that community pharmacy could have on individuals identified as potentially having dementia and patients being treated for dementia, and gather the evidence of those outcomes.

Avon LPC was announced as the successful bidder at the LPC Conference on the 5th November 2013.

Their project consisted of a three tier service:

Tier 1

Initial assessment using the CQUIN question “Have you become more forgetful over the past 12 months to the extent that it has affected your life?” If patients answered positively or if people were unsure they were offered the service and registered.

Tier 2

Patients were offered a Mini-Cog test, which consisting of the following:

• Listening to and then remembering three words;
• Drawing a clock face showing a certain time; and
• Reciting three words back to the pharmacist.

Tier 3

Pharmacists carried out a review of the patient’s medicines focusing on medicines specifically known to cause symptoms similar to dementia or medicines that may cause further memory loss in a patient suffering from dementia. Patients were offered lifestyle advice, information and signposting to local support services where appropriate.

Following the assessment a follow up was completed 4-8 weeks later to see if any patients had been diagnosed with dementia, if patient had experienced any changes to their condition following the medicines review and any outcomes from lifestyle and signposting interventions.