In an era of austerity and widening health inequalities, the effective targeting and uptake of services is essential to minimise additional cost and care burdens in health and social care. This is particularly pertinent to older populations who, with population ageing, place increasing demand on already strained services. This project will identify differences in care pathways (points of contact within primary and secondary care) for patients with a dementia diagnosis (aged 65 and over, as well as people with young-onset dementia (ages 18-64)), both in terms of their trajectory through care and how these trajectories relate to different health and economic outcomes. It will then examine the socio-economic and geographic determinants of these contrasting pathways, establishing the extent to which care pathways and outcomes vary both by people and by places. Places are identified in terms of whether they are in urban or rural locations, rather than their specific geography.
The CPRD resource will allow us to examine the utilisation of primary and secondary care in older adults (65+) and people with young-onset dementia (aged 18-64) in England. As a longitudinal multi-method quantitative study, we will focus on applying innovative sequencing approaches to achieve the stated objectives. Extracting individuals with a dementia diagnosis from the CPRD database, we will construct a longitudinal data resource that sequences periods of care including what type of care was received. This will form the inputs to sequence analysis which will classify these trajectories of care over time resulting in a common set of pathways. Following interpreting these pathways, we will examine how they relate to multiple health (all-cause mortality, Charlson score of comorbidity calculated at end of follow-up period, length of in-patient admissions, number of out-patient visits) and economic (total cost of treatment according to primary care prescribing) outcomes using regression analyses (both linear and multinomial logistic regression depending on the outcome). We will then explore how our pathways vary by age, sex, socioeconomic (e.g. neighbourhood deprivation) and geographical (e.g. urban and rural status) measures through multi-nominal regression.
Charlson score of comorbidities; all-cause mortality (date of death); Length of in-patient admissions during the study period; Number of out-patient visits; total cost of treatment received (primary care prescribing).
Frances Darlington-Pollock - Chief Investigator - University of Liverpool
Frances Darlington-Pollock - Corresponding Applicant - University of Liverpool
Asangaedem Akpan - Collaborator - University of Liverpool
Clarissa Giebel - Collaborator - University of Liverpool
Mark Green - Collaborator - University of Liverpool
2011 Rural-Urban Classification at LSOA level;HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;Patient Level Index of Multiple Deprivation