Research Department of Primary Care and Population Health, University College London, UK.
Trials. 2010 Feb 10;11:13. doi: 10.1186/1745-6215-11-13.
The National Dementia Strategy seeks to enhance general practitioners' diagnostic and management skills in dementia. Early diagnosis in dementia within primary care is important as this allows those with dementia and their family care networks to engage with support services and plan for the future. There is, however, evidence that dementia remains under-detected and sub-optimally managed in general practice. An earlier unblinded, cluster randomised controlled study tested the effectiveness of educational interventions in improving detection rates and management of dementia in primary care. In this original trial, a computer decision support system and practice-based educational workshops were effective in improving rates of detecting dementia although not in changing clinical management. The challenge therefore is to find methods of changing clinical management. Our aim in this new trial is to test a customised educational intervention developed for general practice, promoting both earlier diagnosis and concordance with management guidelines.
DESIGN/METHOD: The customised educational intervention combines practice-based workshops and electronic support material. Its effectiveness will be tested in an unblinded cluster randomised controlled trial with a pre-post intervention design, with two arms; normal care versus the educational intervention. Twenty primary care practices have been recruited with the aim of gaining 200 patient participants. We will examine whether the intervention is effective, pragmatic and feasible within the primary care setting. Our primary outcome measure is an increase in the proportion of patients with dementia who receive at least two dementia-specific management reviews per year. We will also examine important secondary outcomes such as practice concordance with management guidelines and benefits to patients and carers in terms of quality of life and carer strain.
The EVIDEM-ED trial builds on the earlier study but the intervention is different in that it is specifically customised to the educational needs of each practice. If this trial is successful it could have implications for the implementation of the National Dementia Strategy.
NCT00866099.
国家痴呆症战略旨在提高全科医生在痴呆症方面的诊断和管理技能。在初级保健中尽早诊断痴呆症很重要，因为这可以让痴呆症患者及其家庭护理网络能够获得支持服务并为未来做计划。然而，有证据表明，痴呆症在全科医生中仍然未被充分发现和管理不善。一项较早的、未设盲的、聚类随机对照研究测试了教育干预措施在提高初级保健中痴呆症的检出率和管理效果。在最初的试验中，计算机决策支持系统和基于实践的教育研讨会在提高痴呆症检出率方面是有效的，尽管没有改变临床管理。因此，挑战在于找到改变临床管理的方法。我们在这项新试验中的目标是测试一种针对全科医生开发的定制化教育干预措施，该干预措施旨在促进早期诊断和与管理指南的一致性。
设计/方法：定制化教育干预措施结合了基于实践的研讨会和电子支持材料。它的有效性将在一项未设盲的聚类随机对照试验中进行测试，该试验采用前后干预设计，有两个组：常规护理与教育干预。已经招募了 20 个初级保健实践，目标是获得 200 名患者参与者。我们将研究干预措施在初级保健环境中是否有效、实用和可行。我们的主要结局测量指标是每年至少接受两次痴呆症特定管理评估的痴呆症患者比例增加。我们还将检查重要的次要结局，如实践与管理指南的一致性，以及对患者和护理人员的生活质量和护理人员压力的好处。
EVIDEM-ED 试验建立在早期研究的基础上，但干预措施有所不同，因为它是专门根据每个实践的教育需求定制的。如果这项试验成功，它可能对国家痴呆症战略的实施产生影响。
NCT00866099。
