Stephens, Thomas James; (2022) An economic analysis of the quality of primary care for the management of comorbidities in patients living with dementia. Doctoral thesis (Ph.D), UCL (University College London).

Preview

Text Stephens_000_Thesis.pdf - Accepted Version Download (6MB) | Preview

Abstract

The thesis examines the quality of primary care services across a range of comorbid conditions in patients with dementia. The key aims were to assess whether their dementia diagnoses may hinder access to high quality care compared to patients without a cognitive impairment older adults, the health implications of this, and whether quality could be modified. An economic framework is proposed, suggesting that the quality of care received is a function of the supply and demand for quality. Patients with dementia may have a diminishing demand for quality due to a decreased comprehension of their health status as cognitive function declines. On the supply side, quality care provided by physicians may be a function of the availability of resources and the motivation to provide high quality care, which could be financial or not. A systematic literature review and meta-analysis was conducted and highlighted that a diagnosis of dementia is associated with not meeting quality indicators for a range of non-dementia conditions. Subsequent analysis on the English Longitudinal Survey of Ageing, including care quality indicators specifically selected for UK older adults, supports these findings in suggesting that quality is unequal between patients with dementia and patients without cognitive impairments. Further analysis showed that meeting some of these indicators was associated with improved survival and could reduce social care use in patients with dementia, implying that care quality should be improved. In order to assess how care quality and the consequential health outcomes could be improved for patients with dementia, later analyses in this thesis aimed to identify interventions or policies that could improve care quality. Pay-for-performance measures (the Quality and Outcomes Framework) as well as higher levels of cognitive function in patients with dementia appear to be associated with higher quality care. I developed an early model to evaluate the potential cost-effectiveness of introducing a cognition and independence promoting intervention or expanding the QOF to provide additional incentives for patients with dementia. Expanding the QOF does not appear to be cost-effective compared to current practices, though there may be some benefit in promoting cognition and independence in patients with dementia. However, further research on the valuation of health in patients with dementia is required to validate these findings within current willingness-to-pay frameworks for healthcare. The findings of this thesis show that there are some inequalities in the delivery of high-quality primary care, to the detriment of health of patients with dementia. It is implicated that there may be economically efficient strategies to improve health outcomes for patients with dementia by promoting independence.

Download activity - last month

Export as XMLJSONCSV

Download activity - last 12 months

Export as CSVJSONXML

Downloads by country - last 12 months

Export as XMLJSONCSV

Archive Staff Only

View Item