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Re: Accuracy of general hospital dementia diagnoses in England: Sensitivity, specificity, and predictors of diagnostic accuracy 2008–2016
Author(s) -
Sommerlad Andrew,
Perera Gayan,
SinghManoux Archana,
Lewis Glyn,
Stewart Robert,
Livingston Gill
Publication year - 2019
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2018.11.001
Subject(s) - dementia , public health , library science , medicine , psychology , family medicine , psychiatry , disease , nursing , pathology , computer science
Thank you for inviting us to respond to the letter from Wilkinson et al. [1] about our recent article on in-hospital diagnosis of dementia. [2] We found that dementia diagnosis was recorded in only 63% of admissions of people with previously diagnosed dementia to a general hospital and that there were sociodemographic differences in diagnostic sensitivity. This figure is slightly higher than that reported in previous studies [3], and there are a number of potential explanations for this, including that our research used more recent data than any previous study and that there has been a welcome increase in dementia awareness among clinicians and the general public, as well as increased coding accuracy [4] during this time. We echo the call from Wilkinson et al. for improvements in information sharing between different clinical services. For example, automatic population of hospital database records with previously diagnosed conditions would certainly increase clinician awareness of preexisting conditions and allow these to be considered in acute treatment and discharge-planning decisions. We acknowledge that this may be a particular problem in the United Kingdom as, despite the National Health Service making it theoretically feasible for records to be shared, primary care and secondary physical and mental health care services are usually provided by separate organizations with distinct and often incompatible IT systems [5], as recently highlighted by the Kings Fund. This problem likely extends to other countries where care is provided by individual practitioners rather than from a national health service. On the other hand, substantial progress has been made in obtaining research data from routine health care records, as exemplified by the Clinical Record Interactive Search platforms at our clinical sites which are opening up the potential to highlight such issues [6,7]. However, we also believe that our findings show important and worrying variations in diagnostic practice. If the low diagnosis could be solely attributed to the lack of recon-