Can psychiatric liaison reduce neuroleptic use and reduce health service utilization for dementia patients residing in care facilities

Abstract

Background: The quality of care and overuse of neuroleptic medication in care environments are major issues in the care of elderly people with dementia. Method: The quality of care (Dementia Care Mapping), the severity of Behavioural and Psychological Symptoms (BPSD - Neuropsychiatric Inventory), expressive language skills (Sheffield Acquired Language Disorder scale), service utilization and use of neuroleptic drugs was compared over 9 months between six care facilities receiving a psychiatric liaison service and three facilities receiving the usual clinical support, using a single blind design. Results: There was a significant reduction in neuroleptic usage in the facilities receiving the liaison service (McNemar test p < 0.0001), but not amongst those receiving standard clinical support (McNemar test p = 0.07). There were also significantly less GP contacts (t = 3.9 p = 0.0001) for residents in the facilities receiving the liaison service, and a three fold reduction in psychiatric in-patient bed usage (Bed days per person 0.6 vs. 1.5). Residents in care facilities receiving the liaison service experienced significantly less deterioration in expressive language skills (t = 2.2 p = 0.03), but there were no significant differences in BPSD or wellbeing. Conclusion: A resource efficient psychiatric liaison service can reduce neuroleptic drug use and reduce some aspects of health service utilization; but a more extensive intervention is probably required to improve the overall quality of care. Copyright © 2002 John Wiley & Sons, Ltd.