Dementia Early Recognition and Response in Primary Care

Official Title: “Evidence-based Interventions In Dementia EVIDEM-ED: Early Recognition and Response in Primary Care”

The purpose of this study is to develop and test an educational intervention for dementia in primary care, combining timely diagnosis, psychosocial support around the period of diagnosis and management concordant with guidelines.

Dementia presents many challenges for primary care. Early diagnosis is important as this allows those with dementia and their family care networks to engage with support services and plan for the future. These actions can relieve the significant psychological distress that people with dementia and close supporters may experience , and provide knowledge about the availability of medical and psycho-social support that can improved functioning and morale

The main efforts to improve the identification and diagnosis of dementia should logically be targeted at primary care as this is the first point of contact for most individuals and their carers when faced with experiences of 'ill health'. There is, however, evidence that dementia remains under-detected and sub-optimally managed in general practice . An educational intervention that could enhance clinical practice, improving the skills of practitioners in the recognition of and response to dementia syndromes, could therefore be beneficial to people with dementia and their families, and potentially to health and social services.

Intervention(s) in this Clinical Trial

• Other: Educational Dementia training
  • Tailored learning activities on dementia, over a three-month period and will be given an electronic training manual (based on Microsoft packages) which they can run in the background during and after consultations with people with known or suspected dementia syndrome and face-to- face individualised workshop sessions. Tailoring of the education programme is carried out in a three step process: 1) an educational needs analysis is carried our using a standard checklist to identify aspects of dementia care which the practice perceives as problematic for them; 2) a prescription for education is then written to address shortcomings; 3) the best forms of learning are then identified.

Arms, Groups and Cohorts in this Clinical Trial

• No Intervention: "Normal Care"
  • Primary care practices randomly allocated will be given a summary of the NICE/SCIE dementia guidelines (2006) and offered workshop training and software at the end of the study.
• Experimental: Training
  • Practices randomly allocated to the intervention arm will be asked to participate in tailored learning activities on dementia, over a three-month period and will be given an electronic training manual (based on Microsoft packages) which they can run in the background during and after consultations with people with known or suspected dementia syndrome and face-to- face individualised workshop sessions.

Primary Measures

• An increase in the proportion of patients with dementia receiving two dementia reviews per year, from 20% to 50%
  • Time Frame: twelve month follow up
    Safety Issue?: No

Secondary Measures

• quality of life, met and unmet need in carers and/or people with dementia
  • Time Frame: twelve month follow up
    Safety Issue?: No
• documented concordance with intervention recommendations on recording disclosure decisions & consequences
  • Time Frame: twelve month follow up
    Safety Issue?: No
• documented concordance with screening for depression
  • Time Frame: twelve month follow up
    Safety Issue?: No
• documented concordance with referral to social services
  • Time Frame: twelve month follow up
    Safety Issue?: No
• documented concordance with informing people with dementia and their carers about relevant local voluntary organisations
  • Time Frame: twelve month follow up
    Safety Issue?: No
• documented concordance with provision of legal information
  • Time Frame: twelve month follow up
    Safety Issue?: No
• documented concordance with shared management of cholinesterase inhibitor medication
  • Time Frame: twelve month follow up
    Safety Issue?: No

Inclusion Criteria:

• Patients with memory or other cognitive impairments suggestive of dementia syndrome
• those with a formal diagnosis of dementia, of any type.

Exclusion Criteria:

• Patients and carers who are already involved in concurrent research
• If the key professional feels that an approach to the person with dementia or their carer would be inappropriate, for example the dementia is very severe, or that an approach may increase distress
• and any other important reason that the key professional may have for why the person with dementia or their carer should not be contacted.

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?: No

Lead Investigator: University College, London Other

Overall Clinical Trial Officials and Contacts

Jane Wilcock, MA(hons) MSc Principal Investigator University College, London  

Overall Contact: Steve Iliffe, BScMBBSFRCGP 0044-207-830-2393 s.iliffe@pcps.ucl.ac.uk

Information obtained from ClinicalTrials.gov on February 12, 2012

Link to the current ClinicalTrials.gov record. http://clinicaltrials.gov/show/NCT00866099

Study ID Number: FIS No: 49287

ClinicalTrials.gov Identifier: NCT00866099

Health Authority: United Kingdom: Research Ethics Committee

programme website