The above NICE appraisal has been considered by NHS Quality Improvement Scotland through its revised procedure of processing of NICE appraisals (http://www.nhsqis.org/nhsqis/files/NICEGuidanceProcess.pdf):
Web Reference for Guidance and other related documents: http://www.nice.org.uk/guidance/TA111
NHSScotland should note that:
- NHS Quality Improvement Scotland advises that this NICE appraisal is as valid for Scotland as for England and Wales.
- However, in line with existing practice in Scotland, when access to a specialist is not possible, or may be unacceptably delayed due to local circumstances, diagnosis may be made by a general practitioner who has substantial experience in the diagnosis of dementia.
- In cases where clinical diagnosis is judged to be straightforward, treatment may be initiated and re-assessed by the experienced general practitioner according to a shared-care protocol which should include telephone consultation with a specialist and clear treatment end points.
- The NICE appraisal discusses (but does not endorse) an individualised approach to the use of cognition (the Mini Mental State Examination or MMSE) scores for specific groups of people with Alzheimer s disease, such as those with learning difficulties. However, it notes that learning disability specialists were best placed to judge entry and continuation criteria for people with learning difficulties that could be considered equivalent to the general Alzheimer s population . NHS Quality Improvement Scotland reiterates this view to NHSScotland.
- NHS Quality Improvement Scotland also reminds NHSScotland that drugs are only one part of a range of services needed for people with Alzheimer s disease and would commend the following other activities in this area:
- SIGN published its guideline 86, Management of patients with dementia, in February 2006 (http://www.sign.ac.uk/pdf/sign86.pdf). This makes a number of recommendations and covers the patient pathways for all people with dementia and not just those with Alzheimer s disease.
- NHS Quality Improvement Scotland is developing an Integrated Care Pathway to assist NHS Boards to deliver services for people with dementia.
- NHSScotland should take account of the NICE appraisal and this NHS Quality Improvement Scotland email in its planning, funding and provision of services to ensure that recommended drugs or treatments are made available to meet clinical need.
- NHS Quality Improvement Scotland advice represents the evidence-based view of NHS Quality Improvement Scotland.
- This advice does not override or replace the individual responsibility of health professionals to make appropriate decisions in the circumstances of their individual patients, in consultation with the patient and/or guardian or carer.
- No other publications on the NICE appraisal will be issued by NHS Quality Improvement Scotland.
- Hard copies of the NICE appraisals are available from NHS Quality Improvement Scotland (contact Shonagh Buchanan, tel 0141 225 6993 or email shonagh.buchanan@nhshealthquality.org).