Dementia patients face 'postcode lottery' when accessing medication

People with dementia who live in some of the poorest areas of England are less likely to receive medication than those living in more affluent parts of the country, a new study has found.

The latest research conducted by University College London (UCL), has suggested that a 'postcode lottery' still exists in the quality of care people living with dementia receive.

Patients with dementia from more affluent areas in England were found to be 27 per cent more likely to be prescribed anti-dementia drugs that patients from poorer areas.

Head of policy at Alzheimer’s Society, George McNamara, said: “It is unacceptable that such discrimination should exist in accessing healthcare. This research shows that the poorest people in society are still missing out on vital anti-dementia treatments.

“By 2021, there will be over one million people in the UK living with dementia - access to the medication they need should be the same, whether they are living in Kingston-upon-Thames or Kingston-upon-Hull.

“We urge NHS England to put an end to this postcode lottery, and call on healthcare professionals working in these deprived areas to alert their patients to all the treatment options available. It is essential that we have the right strategies in place to support all people living with dementia to successfully navigate the health and social care system and get the treatments they need, regardless of where they live.”

The study was funded by the Dunhill Medical Trust, using 77,045 anonymised medical records of dementia patients from across the UK from 2002-2013, looking at dementia diagnoses and prescriptions. It showed disparity between patients living in England, while the same inequality was not present in Scotland, Northern Ireland or Wales.

The research is published in Age and Ageing found that anti-dementia drugs were prescribed more often in Scotland, Northern Ireland and Wales, than England. More than 37 per cent of patient records studied, received at least one anti-dementia drug prescription during the study period. It was observed that prescription rates fell in all countries during 2006-2009, which was likely to be caused by changing guidelines.

The National Institute for Health and Care Excellence (NICE) amended their guidelines for certain anti-dementia drugs, deciding that they should only be prescribed to people with moderate, not mild dementia. The decision was reversed in 2009, recommending that people with mild dementia should have access to drug treatments.

'Inequality in dementia drug prescriptions in the UK looks to be a uniquely English problem'

Author of the UCL study, Dr Claudia Cooper from the Department of Psychiatry, commented: “When access to any treatment is rationed, wealthier patients and their families tend to be better-equipped to navigate the healthcare system and get around the restrictions.

“They might do more research and know what to do to get the diagnosis and treatment that they want. They could also be more confident and assertive in asking doctors for specific treatments. Observational studies like this can increase our understanding of possible links between inequality and treatment outcomes, but they do not show direct cause and effect as we cannot rule out other explanations.”

Currently, doctors in Scotland are able to choose to follow guidelines from NICE or the Scottish Intercollegiate Guidelines Network (SIGN). The SIGN guidelines do not restrict access based on the severity of the disease, which could help to explain why Scotland does not have significant treatment inequalities.

In 2009, the English National Dementia Strategy was launched with the key objective of reducing treatment inequalities, however, the new study reveals no evidence that this is being achieved when prescribing anti-dementia drugs.

Dean of the UCL Faculty of Brain Sciences, Professor Alan Thompson, commented: “Making sure that everyone has equal access to dementia treatments is just as important as developing new ones. Dementia is not simply a medical issue, it is also a social, political and economic challenge. At UCL, we are committed to tackling dementia across all fronts using the incredible breadth and depth of expertise available to us.”

Dr Cooper added: “Inequality in dementia drug prescriptions in the UK looks to be a uniquely English problem, which could be down to the differing health policies of the devolved nations.

“For example, Scotland and Northern Ireland tend to spend more on health, and prescribe more dementia drugs overall than England; treatments that are more available to all are probably less likely to be unequally distributed as they are more accessible to everyone including people from more deprived areas.

“We urgently need strategies to improve access to dementia treatments for people in more deprived areas in England. These should focus on offering drug treatments to people with treatable dementia types of any severity and ensuring that future prescribing policies do not introduce barriers to care that are less penetrable to people in poorer areas.”