Machine-learning based identification of undiagnosed dementia in primary care: a feasibility study.

BACKGROUND: Up to half of patients with dementia may not receive a formal diagnosis, limiting access to appropriate services. It is hypothesised that it may be possible to identify undiagnosed dementia from a profile of symptoms recorded in routine clinical practice. AIM: The aim of this study is to develop a machine learning-based model that could be used in general practice to detect dementia from routinely collected NHS data. The model would be a useful tool for identifying people who may be living with dementia but have not been formally diagnosed. DESIGN & SETTING: The study involved a case-control design and analysis of primary care data routinely collected over a 2-year period. Dementia diagnosed during the study period was compared to no diagnosis of dementia during the same period using pseudonymised routinely collected primary care clinical data. METHOD: Routinely collected Read-encoded data were obtained from 18 consenting GP surgeries across Devon, for 26 483 patients aged >65 years. The authors determined Read codes assigned to patients that may contribute to dementia risk. These codes were used as features to train a machine-learning classification model to identify patients that may have underlying dementia. RESULTS: The model obtained sensitivity and specificity values of 84.47% and 86.67%, respectively. CONCLUSION: The results show that routinely collected primary care data may be used to identify undiagnosed dementia. The methodology is promising and, if successfully developed and deployed, may help to increase dementia diagnosis in primary care.

Study of psychiatric admission patterns before and after out-patient psychotherapy in a district service setting.

There is a need for evidence to demonstrate the clinical and economic effectiveness of psychotherapy as a component of mental health service delivery. A naturalistic cohort study was carried out in a specialist psychotherapy department in a district mental health service. Thirty-six patients were identified with hospital admissions in the study period who had also received a course of outpatient psychotherapy. There was a significant decrease in hospital in-patient usage temporally associated with receipt of psychotherapy and associated cost savings. Out-patient psychotherapy leads to less in-patient bed usage and significant health-care savings among previously hospitalized psychiatric patients (approximately 6700 pounds sterling per patient).