Joined up care and research in dementia: Braiding the strandsPranathi Ramachandra

Caring for dementia patients

Plaques and tangles?

Primary care

Neurology

A&E

Older people’smental health

Medicine for elderly

Social care

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net’ Parallel information systems Outdated information storage and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

Trying to make sense Audit of OPMHS memory assessment service

2009 7 teams March to September 2009 650 new referrals 17 patients of dementia pathway???!!!! – IT

report after 6 weeks 3 months of plodding through paper files – 450

referrals for memory problems, 187 new onset

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

Partners CLAHRC OPMHS IPH CPFT IT CUHFT DeNDRoN

Process For CPFT coding

IT OPMHS colleagues Admin staff

For dementia register Neurology DME GPs

DH DeNDRoN 3rd sector BRC SLAM

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’

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

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

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

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

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