1. Balancing the costs and quality of different memory service models Dr Judy Rubinsztein Dr Marelna Van Rensburg Dr Zerak Al-Salihy, Dr Deborah Girling, Dr L ouise Lafortune, Dr Murali Kartha, Prof Carol Brayne

2. Aims Evaluate average unit cost to secondary care for patients presenting with memory problems in a Memory Clinic based service (Gp A) and a Traditional ( CMHT based) service ( Gp B). Evaluate quality of diagnostic service offered to patients and carers.

3. Methods Adapted Client Service Receipt Inventory (CSRI) Questionnaire about quality of diagnostic service provided, devised for study

4. Unit Costs for Health and Social Care (2011) ServiceUnit Cost (with on costs) Consultant Psychiatrist £162 Registrar£73 Ass Sp£131 CMHT ( OP)£44 Psychologist£60 CT/ MRI£121/£198 Psych tests£9 Mileage54p/mile

5. Quality Questionnaire: Diagnostic Assessment Response times for assessment Dementia blood screen Pre-diagnostic counselling Examination of cognition, behaviour, functioning Advanced planning discussions Assessment of risk

6. Typical pathway and costs for Gp A screen/assign Pre-Dx Counselling Dx Office DV Post Dx Advice

7. Group B No F/U DV (medical) Assign DVs for post Dx advice, team DV (medical)

8. Demographics A (n=33)B (n=33)Comments Age (mean)80840.03 (Significant) Min-Max65-9266-97 Females58%67% MMSE (median)2425NS (n=32 both groups) ACE-R67-(Gp B, 9 done) Education15 Not recorded 4 in Gp A, 20 in Gp B

9. Diagnoses (NS)

10. Dementia Blood Screen from GP Group AGroup B Yes100%73% Significantly more in Group A Fisher Exact P=0.02

11. Pre-Diagnostic Counselling Prediagnostic CounsellingGp AGP B Yes97%6 % Highly Significant Difference on Chi Sq

12. Days to be seen Group AGroup B Mean days ( SE)25 ( 2.6)20 (3.4) t=1.21P=0.23 (NS)

13. Diagnostic Assessment: informal Evidence of informal assessment ( NS differences) in nearly all of patients including assessments of 1) Functioning 2) Behaviour 3) Global severity 4) Depression 5) Carer assessment : Gp A> Gp B

14. Diagnostic assessment (formal scales) Formal assessment Gp A> Gp B Functioning (P<0.0001) ( BDI) Behaviour (P<0.0001) ( CBI) Global (P<0.0001) (HoNos, EQ5D)

15. Brain Scans

16. Risk Assessment Gp AGp B Documented in94%67% Fisher Exact, P =0.02

17. Post Diagnostic Advice Advance planning discussions 55%45% Third sector 70%24% * Signposting 67%49%

18. Medications Prescribed (65%)

19. Diagnostic info 100% of letters to GP had diagnosis

20. Copying of letters to Pts/ Carers 88% 42% Group A Group B

21. Total Costs Group A Group B PoundsPounds

22. Costs by Type (Means)

23. Conclusions Costs less for Gp A than Gp B but not significantly so. BUT, Gp A (memory clinic service) can offer a higher quality service with more specialist and multi-disciplinary care.

24. Outcome of Study Valuable input to both services re cost and quality of service Developed useful cost and quality tools for evaluating a memory service Cost data may be useful to Unit Costs for Health and Social Care compendium Planning an academic paper!

25. What did I learn? In real world, services change and develop. Neither services are the same as when project done! Involving staff with data collection/discussion at both ends critical to success. Similar stakeholder info re perceived quality of services would be useful.

26. Acknowledgements *Dr Judy Rubinsztein ¥Dr Marelna Van Rensburg **Dr Zerak Al-Salihy, ¥ D Girling, *Dr L Lafortune *Dr Murali Kartha, *Prof Carol Brayne *Receive support from NIHR CLAHRC, University of Cambridge, ¥ CPFT= Cambridge and Peterborough FT **Norfolk and Suffolk FT

27. Acknowledgements Sam Norton (statistician, CLAHRC) John Battersby ( ERPHO, advice on demographic matching) Multidisciplinary staff in both Groups A and B