How to run a search to boost your dementia prevalence

Dementia carries a high value for each person on the register, so finding even one additional patient that should be on it will make a search worthwhile.

There are two searches that can be used to find patients who might be missing from the register – medications prescribed and referral to a memory clinic.

1. Search for medication

There are four medications used for dementia – memantine, rivastigmine, donepezil and galantamine. All of these are in section 4.11 of the BNF so you can use this section as the basis of the search.

Depending on your local arrangements for the prescription of these drugs you may want to search for prescriptions issued or simply drugs on the repeat section of the patient’s medication record.

Step 1. Include patients

You want to include patients who are receiving dementia medications (section 4.11 of the BNF)

Alternatively search for the four medications:

• Memantine
• Rivastigmine
• Donepezil
• Galantamine

With these drugs, prescription at any time in the past is likely to be related to a diagnosis of dementia.

Step 2. Exclude patients

You then need to exclude any patients who are already on the dementia register.

*This is an inactive concept and should not be used for new diagnosis. It is likely to be used for a lot of existing patients, however.

This is a great simplification of the QOF rules, so it won’t pick up every patient already on the register.

There is a ready-made search in EMIS that you can use for the above. Pick ‘use existing rule’ and then ‘earliest occurrence of dementia’. This a rule that gives the earliest date for a dementia diagnosis, but we are just interested in whether they have a diagnosis at all.

See screenshot below of how the EMIS search above looks:

2. Search for memory clinic referral

The relatively high amount for each patient with dementia can make a slightly more speculative search worthwhile.

When a patient is referred to a memory clinic there is a reasonably high chance that they will be diagnosed with dementia. It can be worthwhile to review patients who have been referred to make sure that any diagnosis is correctly coded.

This is particularly valuable if medication is being prescribed by the clinic, meaning it won’t necessarily be picked up it he first search, or if no medication is being prescribed.

Step 1. Include patients

Step 2. Exclude patients

Patients who are already on the register. See step 2 of medication search.