Enhancing Dementia Care: A Pilot Study on the Impact of a Clinical Pharmacist in a Memory Service. (2025)

North East Foundation Trust 

Project summary

Background and Introduction
The Redbridge Memory Clinic faced urgent challenges due to a growing aging population and increasing referrals, leading to workforce, capacity, and workload issues. With over 180 patients on the waiting list, the clinic struggled to meet the national target of diagnosing 67% of patients within six weeks. Consultant availability was limited, impacting diagnostic assessments, while long-term prescription patients lacked regular reviews. Coordination issues in medication management further compounded these problems. In response, the clinic redesigned its service model through a 12-week pilot, introducing a clinical pharmacist to manage post-diagnostic appointments, medication titrations, and prescription reviews.

Aims and Objectives
This initiative aims to improve efficiency and meet diagnostic targets. The clinic's redesign focuses on four goals: 1. Increase capacity by providing 16 additional titration and post-diagnostic appointments in 4 weeks. 2. Release consultant time for diagnostic appointments by adding skills to handle medication queries, titration, and follow-up appointments, helping meet the national diagnostic rate of 67%. 3. Improve care quality and patient experience with timely dose titration, medication side-effect monitoring, safeguarding, and structured reviews ensuring vascular factors and long-term condition management in place. 4. Enhance service quality by reducing the time between referral initiation and diagnosis.

Method
The method involved launching a 12-week pilot program with several key strategies: 1. Baseline Audit: Identified a 6.7-week delay in medication titration, highlighting the need for intervention. 2. Memorandum of Understanding (MOU): Partnered with the Lead Pharmacist for Frailty and Older Persons, allowing a pharmacist to deliver titration clinics and discharge the patients from the service – 0.2 wte (2 clinics) for 3 months (April-June 2024). 3. Structured Pathways: Developed a pharmacist prescription titration clinic pathway to reduce burden of reviewing anti-dementia medications, BPSD (Behavioural and psychological symptoms of dementia), safeguarding concerns and post-diagnostic support by the consultant.

Results
The pilot led to notable improvements: -Diagnostic Rate: Increased from 64.0% to 64.35%, moving closer to the 67% target. -Reduced Titration Time: The average time to the first titration appointment decreased from 6.7 to 5.8 weeks. -Consultant Time Freed: Reallocating 42 follow-up appointments to the pharmacist saved 28 consultant hours (£3,790.80), redirected to diagnostics. -Pharmacist-Led Interventions: The pharmacist managed 42 follow-ups, issued 32 prescriptions, made 44 GP recommendations, and completed 31 structured medication reviews. Additionally, 12 patients were reviewed for side effects, and 16 referrals were made to occupational therapy, social services, and the Community Mental Health Team (CMHT).