Prescribing for People with Dementia; Selected Findings from POMH-UK Quality Improvement Programmes (QIPs)

The Prescribing Observatory for Mental Health (POMH-UK) is a national initiative to improve the quality of prescribing practice in mental health services through audit-based quality improvement programmes (QIPs). POMH-UK is based in the Centre for Quality Improvement at the Royal College of Psychiatrists and is funded wholly through subscriptions from member Trusts (n=63 in 2016/17).

POMH-UK identifies areas of prescribing practice that are suitable for QIPs, convenes an expert steering group, agrees clinical practice standards based on NICE and other evidence-based guidelines and provides bespoke data collection tools. Audit data are collected by clinicians and clinical audit staff in participating Trusts and are submitted on-line. POMH analyse these data and provide benchmarked audit reports that allow Trusts and teams within these Trusts to compare their prescribing practice with the audit standards and with each other.

POMH-UK have conducted two QIPs that are relevant to this clinical guideline. The first focussed on the prevalence and quality of prescribing of anti-dementia medicines; baseline audit in 2007 and re-audit in 2013. The second focussed on the prevalence and quality of prescribing of antipsychotic medication; baseline audit in early 2011, re-audit in late 2012 and a supplementary audit in 2016. For all of these audits, Trusts that opted to participate were asked to provide data on a sample of people with dementia under the care of their services.

Note that POMH-UK member Trusts all provide mental health services. Audit samples are large and reported clinical practice is therefore likely to be representative of mental health services across the UK, however it cannot be generalised to other settings such as acute Trusts and primary care.

Prescribing Anti-Dementia Drugs

The clinical practice standards for this audit were derived from the NICE dementia clinical guideline (CG42; 2012).

54 Trusts participated in the re-audit, submitting data for 9180 patients, of whom 6286 (68%) were prescribed anti-dementia medication.

Performance against the audit standards at re-audit is shown in Table 1 below.

Practice against audit standards 1 and 2 was measured in the sub-sample of patients who had started anti-dementia medication in the previous 6 months (n=1,650), audit standard 3 in those who had been receiving treatment with anti-dementia medication for 7-12 months (n=927) and audit standard 4 in those who had been treated with anti-dementia medication for more than a year (n=3709).

Prescribing Antipsychotic Medication for People with Dementia

The clinical practice standards for this audit were derived from the NICE dementia clinical guideline (CG42; 2012).

53 Trusts participated in the baseline audit, submitting data for 10199 patients, 16% of whom were prescribed anti-psychotic medication in the absence of a diagnosed co-morbid psychotic illness. The respective figures at re-audit and supplementary audit were 51 Trusts, 12799 patients (13% prescribed antipsychotics) and 58 Trusts, 10199 patients (15% prescribed antipsychotic medication) respectively. Performance against the audit standards at each of the 3 audits is shown in Table 3 below.

Practice against audit standards 1 was measured in all patients, audit standards 2-4 in the sub-sample of patients who had started anti-psychotic medication in the previous 3 months and audit standard 5 in those who had been receiving treatment with anti-psychotic medication for more than 6 months.

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