Inequalities in primary and secondary healthcare use among people living with dementia in England
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NIHR Applied Research Collaboration North West Coast (ARC NWC) , The University of Liverpool, United Kingdom
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A4
Background and objectives: In the UK healthcare services for people living with dementia (PLWD) are under pressure, and central government have not adhered to additional funding commitments. The UK population with dementia is expected to surpass 1 million by the year 2024, and the health and social care costs for PLWD set to treble by 2040, making it critical we understand how and to what extent, PLWD differentially use healthcare. This study aimed to explore social and spatial variations in healthcare use among people diagnosed with dementia (2002-2016).  Methods: Data were taken from Electronic Health Records of Clinical Practice Research Datalink General Practice patients in England (n=142,302). Healthcare contacts were standardised for the sample population, with rates of contacts per year calculated for three primary healthcare types (GP observations, and both dementia and non-dementia medications) and three secondary (Accident and Emergency (A&E) attendances, and emergency and elective hospital admissions). Generalised linear regression models, fully-adjusted for confounders enabled identification of differences in healthcare use by socio-economic, demographic and geographic factors. The sample was stratified by dementia onset, with a subsequent series of analyses generated for each healthcare type, Resultsing in 12 regression models. Results: The study highlights several social and spatial inequalities in healthcare use among PLWD. Men, PLWD from White ethnicity groups, in more deprived areas, and from rural areas, have greater use of healthcare services more closely associated with negative health outcomes, including less frequent GP contact and medications, and greater use of secondary healthcare. Conclusions: Social and systemic measures are needed to reduce healthcare use inequalities among PLWD. These include: improved healthcare continuity, more frequent and better-quality health checks and medicines reviews, more culturally appropriate services, as well as greater and more accessible treatment and improved infrastructure for underserved communities.
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