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Code for Dementia Health Review (In last 12 months)

6AB.. Dementia annual review

Dementia Read Codes

Eu02.[X]Dementia in other diseases classified elsewhere
Eu020 [X]Dementia in Pick's disease
Eu021 [X]Dementia in Creutzfeldt-Jakob disease
Eu022 [X]Dementia in Huntington's disease
Eu023 [X]Dementia in Parkinson's disease
Eu024 [X]Dementia in human immunodef virus [HIV] disease
Eu025 [X]Lewy body dementia
Eu02y [X]Dementia in other specified diseases classif elsewhere
Eu02z [X] Unspecified dementia
E00.. Senile and presenile organic psychotic conditions
E000. Uncomplicated senile dementia
E001. Presenile dementia
E0010 Uncomplicated presenile dementia
E0011 Presenile dementia with delirium
E0012 Presenile dementia with paranoia
E0013 Presenile dementia with depression
E001z Presenile dementia NOS
E002. Senile dementia with depressive or paranoid features
E0020 Senile dementia with paranoia
E0021 Senile dementia with depression
E002z Senile dementia with depressive or paranoid features NOS
E003. Senile dementia with delirium
E004. Arteriosclerotic dementia
E0040 Uncomplicated arteriosclerotic dementia
E0041 Arteriosclerotic dementia with delirium
E0042 Arteriosclerotic dementia with paranoia
E0043 Arteriosclerotic dementia with depression
E004z Arteriosclerotic dementia NOS
E00y. Other senile and presenile organic psychoses
E00z. Senile or presenile psychoses NOS
Eu01.% [X]Vascular dementia
E02y1 Drug-induced dementia
E012.% Other alcoholic dementia
Eu00.% Senile and presenile organic psychotic conditions
E041. Dementia in conditions EC
Eu041 [X]Delirium superimposed on dementia
F110.% Alzheimer's disease
F111. Pick's disease
F112. Senile degeneration of brain
F116. Lewy body disease
A4110 Sporadic Creutzfeldt-Jakob disease (v30)

Dementia exception reporting codes (In last 12 months)

9hD0. Excepted from dementia quality indicators: Patient unsuitable
9hD1. Excepted from dementia quality indicators: Informed dissent

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Dementia 002.1 Rationale

The face to face review should focus on support needs of the patient and their carer. In particular the review should address four key issues:

i. an appropriate physical and mental health review for the patient
ii. if applicable, the carer’s needs for information commensurate with the stage of the illness and his or her and the patient’s health and social care needs
iii. if applicable, the impact of caring on the care-giver
iv. communication and co-ordination arrangements with secondary care (if applicable).

An ES for facilitating timely diagnosis and support for people with dementia has been introduced (which builds on the 2013/14 ES). The ES from 1 April 2014 requires practices to develop a care plan which includes an element of advanced care planning (ACP). Where appropriate this should include a record of the patient's wishes for the future, identification of the patients' carer(s) and provide appropriate permissions to authorise the practice to speak directly to the nominated carer(s) and provide details of support services available to the patient and their family.

Patients diagnosed with dementia are expected to be offered annual appointments specifically to review their diagnosis and care plan. The practice will agree with the patient and their carer, what is to be covered in the review and the duration of the consultation - where appropriate, extended consultations may take up to 30 minutes. Ideally the first such appointment would be within six months of diagnosis.

Where a patient with dementia has an advanced care plan, it is expected that this would be reviewed as part of the face-to-face review for this indicator and updated as appropriate.

A series of well-designed cohort and case control studies have demonstrated that patients with Alzheimer-type dementia do not complain of common physical symptoms, but experience them to the same degree as the general population. Patient assessments therefore include the assessment of any behavioural changes caused by:

Depression should also be considered since it is more common in people with dementia than those without (Burt et al. Psychol Bull 1995; 117: 285-305).

Patients and carers are to be given relevant information about the diagnosis and sources of help and support (bearing in mind issues of confidentiality). Evidence suggests that healthcare professionals can improve satisfaction for carers by acknowledging and dealing with their distress and providing more information on dementia. As the illness progresses, needs may change and the review may focus more on issues such as respite care.

There is good evidence from well-designed cohort studies and case control studies of the benefit of healthcare professionals asking about the impact of caring for a person with dementia and the effect this has on the caregiver. It is important to remember that male carers are less likely to complain spontaneously and that the impact of caring is dependent not on the severity of the cognitive impairment but on the presentation of the dementia, for example, on factors such as behaviour and affect. If the carer is not registered at the practice, but the GP is concerned about issues raised in the consultation, then with appropriate permissions they can contact the carer's own GP for further support and treatment.

As the illness progresses and more agencies are involved, the review could additionally focus on assessing the communication between health and social care and non-statutory sectors as appropriate, to ensure that potentially complex needs are addressed. Communication and referral issues highlighted in the review need to be followed up as part of the review process.

Further Information:

NICE clinical guideline CG42. Dementia. Supporting people with dementia and their carers in health and social care. 2006. http://guidance.nice.org.uk/CG42/NICEGuidance/pdf/English

Further information The Audit Commission Report (2002). Forget Me Not.
http://www.auditcommission. gov.uk/nationalstudies/health/mentalhealth/Pages/forgetmenot2002.aspx

The NSF for Older People.
http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/DH_4003066

NICE public health guidance 16 (2008). Mental wellbeing in older people.
http://publications.nice.org.uk/occupational-therapy-interventions-and-physical-activityinterventions-to-promote-the-mental-ph16


NICE clinical guideline 42 (2006). Dementia. Supporting people with dementia and their carers in health and social care. http://guidance.nice.org.uk/CG42/NICEGuidance/pdf/English

No decision has been taken on the endorsement of clinical guideline 42 in Northern Ireland but the position is under review. Information on NICE guidance endorsed in NI may be found at:
http://www.dhsspsni.gov.uk/sqsd-guidance-nice-guidance

SIGN clinical guideline 86 (2006). Managing patients with dementia.
http://www.sign.ac.uk/pdf/sign86.pdf

Coping with Dementia a Handbook for Carers (2009).
http://www.healthscotland.com/documents/1469.aspx

Dementia 002.2 Reporting and verification

See indicator wording for requirement criteria.

Verification NHS England may require randomly selecting a number of patient records of patients in which the review has been recorded as taking place to confirm that the four key issues are recorded as having been addressed, if applicable.

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Prepared By Jean Keenan