NPC Archive Item: National Dementia Strategy to consider antipsychotic use

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A Department of Health review is being conducted as part of the National Dementia Strategy to investigate and suggest actions to reduce the inappropriate prescribing of antipsychotics to people with dementia.

The Department of Health National Dementia Strategy and implementation plan are due for publication in October 2008. They will address three key themes – raising awareness, early diagnosis and intervention, and improving the quality of care of people with dementia. A public consultation document was issued in June with comments due by 11th September 2008. This consultation draws on evidence from a wide range of reports and stakeholders, a series of listening events involving over 3,000 people and the recommendations of an External Reference Group. Inappropriate prescribing of antipsychotics to people with dementia is one of the important issues being considered.

Why is antipsychotic prescribing in people with dementia an important issue?
As widely reported in the media earlier this year, antipsychotics appear to be prescribed inappropriately for many people with dementia (see BBC News). This is despite the Medicines and Healthcare products Regulatory Agency (MHRA) warning with regard to the risk of stroke with atypical antipsychotics and NICE/SCIE guideline recommendations, which restrict the use of antipsychotics to specific circumstances, and then only after full consideration of the risks and benefits (see MeReC Bulletin Vol.18 No.1).

How is the issue being addressed?
A Department of Health review of antipsychotic prescribing in people with dementia is presently being conducted and will be published in early October 2008, ahead of the Dementia strategy. The review group will consider evidence around the issues, any relevant statutory and regulatory provisions, and will consult interested bodies inside and outside of the Department. If necessary, short-term research will be carried out. The research group will review options for change and draw up advice for Ministers prior to publication of the National Dementia Strategy in October 2008. This advice will include the need for further research and the likely economic impact of any recommended changes.

What are the terms of reference for the review?
The review will examine the use of antipsychotic drugs for people with dementia of all ages, including residents of care homes as well as those in the community and in secondary care. It is examining, in particular:

  • the evidence that these drugs are being over-prescribed to people with dementia;
  • existing guidance in relation to the use of the drugs for people with dementia and alternatives to their use;
  • actions that could be taken if it appears that the current guidelines on the use of these drugs for people with dementia are not being followed;
  • what we can learn from practice in other countries;
  • the role of key bodies involved, including the MHRA, the Healthcare Commission, Commission for Social Care Inspection (CSCI), primary and secondary care trust clinical governance systems, and the General Medical Council (GMC);
  • what checks there are in place currently to review the prescribing of these drugs, and whether these are adequate;
  • the guidance that Care Homes have on this issue;
  • how are carers and other family members are involved in decision-making when these drugs are prescribed for people with dementia; and
  • what should people do if they have concerns about inappropriate prescribing.

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