Morris Charlotte, Techache Roukia, Davies Katie, Blakeman Tom, Kontopantelis Evangelos, Ashcroft Darren M, Robinson Dame Louise
NIHR School for Primary Care Research, Department of Primary Care and Health Services Research, The University of Manchester, Manchester, UK.
National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Int J Geriatr Psychiatry. 2024 Dec;39(12):e70035. doi: 10.1002/gps.70035.
International guidelines make recommendations for the delivery of safe, high-quality primary care for people with dementia including prescribing, personalised care planning and regular holistic reviews. It is unclear how the quality and safety of this healthcare varies with socio-economic factors.
This scoping review aimed to understand the depth and breadth of existing evidence exploring socio-economic variation in the quality and safety of primary care for people with dementia.
Prescribing and care planning indicators of high-quality, safe primary care were defined from guidance. Composite and proxy markers of socio-economic status (SES) were defined. EMBASE, MEDLINE, PsychInfo, The Cochrane Database of Systematic Reviews, worldcat.org and clinicaltrial.gov databases were searched. Studies in English, on human participants from 2006 onwards were eligible. Narrative synthesis was conducted. Studies explored how one or more selected indicators (anti-dementia medication and anti-psychotic prescribing, potentially inappropriate prescribing (PIP), medication review, dementia review or care planning) varied with a recognised marker of SES in people with dementia.
Searches identified 1980 studies after removing duplicates. 385 full texts were reviewed, with 53 eligible for inclusion (51 quantitative, 2 reviews). Most identified studies explored prescribing processes (50 quantitative, 2 reviews), with 2 exploring annual review. There was evidence of substantial disparity in quality and safety indicators in studies exploring prescribing; 20/29 (69%) of studies exploring anti-dementia medication prescribing found those with markers of lower SES were significantly less likely to receive these. 16/28 studies exploring PIP/Anti-psychotics found significant disparities in safe prescribing for those with markers of lower SES. Neither study exploring annual reviews found any significant differences across SES.
We found evidence of disparity in the quality and safety of post-diagnostic primary care for people with dementia based on SES, particularly for a range of prescribing indicators. Further work exploring inequalities in care planning and reviews for people with dementia is needed to understand existing inequalities in the quality and safety of primary care for people with dementia.
国际指南就为痴呆症患者提供安全、高质量的初级保健提出了建议，包括开药、个性化护理计划和定期全面评估。目前尚不清楚这种医疗保健的质量和安全性如何随社会经济因素而变化。
本范围综述旨在了解现有证据的深度和广度，这些证据探讨了痴呆症患者初级保健质量和安全性方面的社会经济差异。
根据指南定义高质量、安全初级保健的开药和护理计划指标。定义社会经济地位（SES）的综合指标和替代指标。检索了EMBASE、MEDLINE、PsychInfo、Cochrane系统评价数据库、worldcat.org和clinicaltrial.gov数据库。纳入2006年起以英文发表的、涉及人类参与者的研究。进行叙述性综合分析。研究探讨了一个或多个选定指标（抗痴呆药物和抗精神病药物处方、潜在不适当处方（PIP）、药物审查、痴呆症评估或护理计划）在痴呆症患者中如何随公认的SES指标而变化。
去除重复项后，检索到1980项研究。对385篇全文进行了审查，其中53篇符合纳入标准（51篇定量研究，2篇综述）。大多数已识别的研究探讨了开药过程（50篇定量研究，2篇综述），2项研究探讨了年度评估。在探讨开药的研究中，有证据表明质量和安全指标存在显著差异；在29项探讨抗痴呆药物处方的研究中，20项（69%）发现SES较低指标的患者接受这些药物的可能性显著较低。在16项探讨PIP/抗精神病药物的研究中，发现SES较低指标的患者在安全开药方面存在显著差异。两项探讨年度评估的研究均未发现SES之间存在任何显著差异。
我们发现有证据表明，基于SES的痴呆症患者诊断后初级保健的质量和安全性存在差异，特别是在一系列开药指标方面。需要进一步开展工作，探讨痴呆症患者护理计划和评估中的不平等现象，以了解痴呆症患者初级保健质量和安全性方面现有的不平等情况。
