The aim of the 2009 English National Dementia Strategy was to reduce treatment inequalities, but a new study in Age and Ageing reveals that inequalities in anti-dementia drug (ADD) prescribing persist in England. This is in contrast to Scotland, Wales and Northern Ireland.
The authors investigated associations between Townsend deprivation scores and ADD prescribing in 77,045 dementia patients between 2002 and 2013 using UK primary care records.
In England, people in the least deprived quintile were 27 per cent more likely to receive ADDs than those from the most deprived areas. People in the second and third least deprived quintiles were 11 and 9 per cent more likely to receive ADDs than the most deprived areas.
“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,” says lead author Claudia Cooper, reader in old age psychiatry at University College London. “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 for specific treatments.”
Access to ADDs must improve
Compared with practices in England, ADD prescription rates were 81 per cent higher in Northern Ireland and 14 per cent higher in Scotland, although the latter did not reach statistical significance. ADD initiation rates were 32 per cent lower in Wales than England.
“This was an observational study, so we can only speculate as to the explanations for our findings. Scotland and Northern Ireland prescribe more dementia drugs overall than England. Treatments that are more widely available are probably less likely to be unequally distributed,” Dr Cooper told Pharmacy Magazine. “There is some indication that inequalities in Wales declined over time. However, doctors in Wales prescribe fewer anti-dementia drugs than their colleagues in England, so more severe rationing may also reduce inequalities.”
There is an urgent need to improve access to ADDs for people in more deprived areas in England, says Dr Cooper. “The strategies 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,” she says.