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Referral patterns and acetylcholinesterase inhibitor prescribing for cognitive impairment (1999–2007): impact of NICE guidelines

Published online by Cambridge University Press:  02 January 2018

Yogesh Ganeshalingam ,
Claudia Cooper  and
Gill Livingston
Yogesh Ganeshalingam
Affiliation:
The Ladywell Unit, Lewisham High Street, South London and Maudsley NHS Foundation Trust, London SE13 6LW, email: [email protected]
Claudia Cooper
Affiliation:
University College London, Department of Mental Health Sciences
Gill Livingston
Affiliation:
University College London, Department of Mental Health Sciences
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Abstract

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Aims and Method

We hypothesised that the proportion of people referred to two outer London mental healthcare services for older people with cognitive impairment increased after the 2001 National Institute for Health and Clinical Excellence (NICE) guidelines for acetylcholinesterase (AChE) inhibitor use in Alzheimer's disease, but declined after the amended 2006 guidelines. We reviewed case notes for 546 individuals referred between 1999 and 2007.

Results

The proportion of individuals with cognitive impairment referred increased between 1999 (56.1%) and 2005 (70.5%, χ2=5.4, P=0.02), as did the proportion prescribed AChE inhibitor (0.8% to 16.1%, χ2=27.5, P<0.001). There were no significant changes between 2005 and 2007.

Clinical Implications

The 2006 NICE amendment may have curbed the increase in psychiatric referrals and AChE inhibitor prescribing rates for people with cognitive impairment but so far these rates have not decreased.

Type
Original papers
Information
Psychiatric Bulletin , Volume 32 , Issue 7 , July 2008 , pp. 265 - 267
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2008

References

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National Institute for Health and Clinical Excellence (2001) Guidance on the Use of Donepezil, Rivastigmine and Galantamine for the Treatment of Alzheimer's Disease. Technology Appraisal Guidance, no. 19. NICE (http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11413).Google Scholar
National Institute for Health and Clinical Excellence (2006a) Donepezil, Galantamine, Rivastigmine (Review) and Memantine for the Treatment of Alzheimer's Disease. (Amended). NICE (http://www.nice.org.uk/TA111).Google Scholar
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O'Loughlin, C. & Darley, J. (2006) Has the referral of older adults with dementia changed since the availability of acetylcholinesterase inhibitors and the NICE guidelines? Psychiatric Bulletin, 30, 131–134.CrossRefGoogle Scholar
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