Implementation Study of Dementia Guidelines in Primary Care

Official Title: “How to Reach Evidence Based Practice in Diagnostic Assessment and Management of Dementia by General Practitioners and Primary Care Nurses? The Effectiveness of an EASYcare Based Educational Program.”

The purpose of this study is to determine whether a specially developed Dementia Training Program for duos of general practitioners and primary care nurses is able to increase the number dementia diagnoses in elderly people living in the community and increase the adherence to clinical dementia guidelines

Background Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed in developed countries. In several countries educational interventions were developed to improve dementia diagnosis and management in primary care. Some of these interventions were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff.

However, none of these interventions focussed on collaboration between GPs and nurses in dementia care. We developed a Dementia Training Program (DTP) aimed at stimulating collaboration in dementia primary care. We expect it to increase the number of cognitive assessments and dementia diagnoses, as well as to improve attitudes and knowledge of GPs and nurses.

Methods/Design The DTP is a complex educational intervention and consists of 2 workshops, a coaching program, and case-based consultations either face-to-face or by phone or e-mail, access to an internet forum, and a Computerized Clinical Decision Support System on dementia diagnostics and management. 100 duos of GPs and nurses will be recruited, from which 2/3 will be allocated to the intervention group and 1/3 to the control group. The effects of implementation of the DTP will be studied in an assessor blinded cluster-randomised controlled trial. Primary outcomes are the number of cognitive assessments and dementia diagnosis in a period of 9 months, starting after workshop participation of the duos.

Secondary outcomes are measured on GP and nurse level: rate of adherence to national guidelines for dementia diagnosis, attitude, confidence and knowledge regarding dementia diagnosis and management; on patient level: number of emergency calls, visits and consultations and patient satisfaction; and on caregiver level: informal caregiver burden and satisfaction. Data will be collected from GPs’ electronic medical dossiers, self registration forms and questionnaires. Statistical analysis will be performed by using MANOVA-method. Also, exploratory analyses will be performed, in order to gain insight into barriers and facilitators for implementation and the causal relations between the rate of success of the intervention components and the outcomes.

Intervention(s) in this Clinical Trial

• Procedure: Dementia Training Program

Primary Measures

• Number of dementia diagnoses and cognitive assessments during 9 months

Secondary Measures

• Accuracy tot dementia guidelines, GP and nurse knowlegde and attitude and competence regarding dementia. Patient satisfaction, caregiver burden and satisfaction

Inclusion Criteria:

• GP and practice or district nurse must participate as a duo

Exclusion Criteria:

• None

Gender Eligibility for this Clinical Trial: Both

Minimum Age for this Clinical Trial: N/A

Maximum Age for this Clinical Trial: N/A

Are Healthy Volunteers Accepted for this Clinical Trial?: Accepts Healthy Volunteers

Lead Investigator: Radboud University Other

Overall Clinical Trial Officials and Contacts

Marcel Olde Rikkert, Prof, MD Study Director Alheimer Centre Nijmegen, the Netherlands  

Overall Contact: Marieke Perry, MD 0031-24-3610142 m.perry@ger.umcn.nl

Information obtained from ClinicalTrials.gov on February 12, 2012

Link to the current ClinicalTrials.gov record. http://clinicaltrials.gov/show/NCT00459784

Study ID Number: EASYcareGIDS study

ClinicalTrials.gov Identifier: NCT00459784

Health Authority: Netherlands: The Central Committee on Research Involving Human Subjects (CCMO)