Balancing the costs and quality of different memory service models

Balancing the costs and quality of different memory service models Dr Judy Rubinsztein Dr Marelna Van Rensburg Dr Zerak Al-Salihy, Dr Deborah Girling, Dr L ouise Lafortune, Dr Murali Kartha, Prof Carol Brayne

Aims • Evaluate average unit cost to secondary care for patients presenting with memory problems in a Memory Clinic based service (Gp A) and a Traditional ( CMHT based) service ( Gp B). • Evaluate quality of diagnostic service offered to patients and carers.

Methods • Adapted Client Service Receipt Inventory (CSRI)

• Questionnaire about quality of diagnostic service provided, devised for study

Unit Costs for Health and Social Care (2011) Service

Consultant Psychiatrist Registrar Ass Sp CMHT ( OP) Psychologist CT/ MRI Psych tests Mileage

Unit Cost (with on costs) £162 £73 £131 £44 £60 £121/£198 £9 54p/mile

Quality Questionnaire: Diagnostic Assessment Response times for assessment Dementia blood screen Pre-diagnostic counselling Examination of cognition, behaviour, functioning Advanced planning discussions Assessment of risk

Typical pathway and costs for Gp A

DV

screen/assign Pre-Dx Counselling

Dx

Post Dx

Office

Advice

Group B

DV (medical)

• No F/U

DV (medical)

• Assign • DVs for post Dx advice, team

Demographics A (n=33)

B (n=33)

Comments

Age (mean)

80

84

0.03 (Significant)

Min-Max

65-92

66-97

Females

58%

67%

MMSE (median)

24

25

NS (n=32 both groups)

ACE-R

67

-

(Gp B, 9 done)

Education

15

15

Not recorded 4 in Gp A, 20 in Gp B

Diagnoses (NS) 60

50

40

30

A (%)

B (%) 20

10

0

AD

VD

LBD

MCI

Depression

Other

Dementia Blood Screen from GP Yes

Group A

Group B

100%

73%

Significantly more in Group A Fisher Exact P=0.02

Pre-Diagnostic Counselling Prediagnostic Counselling

Gp A

GP B

Yes

97%

6%

Highly Significant Difference on Chi Sq

Days to be seen Group A

Group B

Mean days ( SE)

25 ( 2.6)

20 (3.4)

t=1.21

P=0.23 (NS)

Diagnostic Assessment: informal Evidence of informal assessment ( NS differences) in nearly all of patients including assessments of 1) Functioning 2) Behaviour 3) Global severity 4) Depression 5) Carer assessment : Gp A> Gp B

Diagnostic assessment (formal scales) Formal assessment Gp A> Gp B • Functioning (P