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Joined up care and research in dementia: Braiding the strands

Joined up care and research in dementia: Braiding the strands. Pranathi Ramachandra. Caring for dementia patients. Social care. Neurology. Medicine for elderly. Older people’s m ental health. Primary care. A&E. Plaques and tangles?. Problems. Too many silos of service provision

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Joined up care and research in dementia: Braiding the strands

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  1. Joined up care and research in dementia: Braiding the strands Pranathi Ramachandra

  2. Caring for dementia patients Social care Neurology Medicine for elderly Older people’s mental health Primary care A&E Plaques and tangles?

  3. Problems • Too many silos of service provision • Errors of commission - Duplication of services • Errors of omission - ‘slips through the net’ • Parallel information systems • Outdated information storage and retrieval • No information about magnitude of need

  4. Trying to make sense • Audit of OPMHS memory assessment service 2009 • 7 teams • March to September 2009 • 650 new referrals • 17 patientsof dementia pathway???!!!! – IT report after 6 weeks • 3 months of plodding through paper files – 450 referrals for memory problems, 187 new onset

  5. Project aims • ICD-10 coding of all new referrals to OPMHS • Record codes electronically • Retrieve reports periodically • Encourage research participation • Ripple effect across the trust • Contribute data to local dementia register

  6. Partners • CLAHRC • OPMHS • IPH • CPFT IT • CUHFT • DeNDRoN

  7. Process • For CPFT coding • IT • OPMHS colleagues • Admin staff • For dementia register • Neurology • DME • GPs • DH • DeNDRoN • 3rd sector • BRC • SLAM

  8. Multiple avatars • CLAHRC fellow • CLAHRC old age theme psychiatrist • Liaison older people’s psychiatrist • Memory clinic psychiatrist • OPMHS research with DeNDRoN • CPFT IT clinical safety officer • General nosey parker, jack of all trades, maverick, ‘dosser’

  9. Acts of God and natural disasters • Services stretched thin • 2 clinical sessions and 8 research sessions in September 2011 • 7 clinical sessions, 1 CLAHRC session and 1 IT session today

  10. However… • ICD Coding becomes norm in OPMHS • Ripple effect – liaison psychiatry and specialist TRD clinic start coding • Coding to be mandatory across trust • Dementia on the map, there to stay • DH working group endorses dementia register is priority project • SLAM IT partner with CPFT to use CRIS for research • Move for national dementia informatics project

  11. Results • 1341 new referrals • 7 teams • 100% coding • 645 dementia • 484 AD • 184 MCI • 114 delirium • 1 international multi-site trial of monoclonal amyloid antibody in prodromal AD • 1 non-commercial multi site national study in LOSLP • 1 RNIB study in visual deficits in dementia • 1 PhD project on end of life decisions in dementia

  12. We’re not perfect • Occurrence at home 12 • Occurrence at other place 1 • Hepatic failure, unspecified 1 • Circumscribed brain atrophy 2 • Anankastic personality disorder 2 • Personality disorder, unspecified 1 • Unspecified mood disorder 1 • Mental retardation with statement, minimal or no impairment 1 • Developmental disorder of scholastic skills, unspecified 1 • Adjustment disorder with predominant disturbance of other emotions 1 • Problems in relationship with spouse or partner 1

  13. The fellowship • Terrific experience • Thinking space and time • Excellent cohort • Great quality and variety of subjects and teachers • ALS sessions are amazing • Great organisationand catering • Special thanks to Christine, Lea, Angela and Diane • Far too short!

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