Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
BMC Public Health. 2012 Aug 4;12:609. doi: 10.1186/1471-2458-12-609.
In the primary care setting, dementia is often diagnosed relatively late in the disease process. Case finding and proactive collaborative care may have beneficial effects on both patient and informal caregiver by clarifying the cause of cognitive decline and changed behaviour and by enabling support, care planning and access to services.We aim to improve the recognition and diagnosis of individuals with dementia in general practice. In addition to this diagnostic aim, the effects of case finding and subsequent care on the mental health of individuals with dementia and the mental health of their informal carers are explored.
cluster randomised controlled trial with process evaluation.
162 individuals ≥ 65 years, in 15 primary care practices, in whom GPs suspect cognitive impairment, but without a dementia diagnosis.Intervention; case finding and collaborative care: 2 trained practice nurses (PNs) invite all patients with suspected cognitive impairment for a brief functional and cognitive screening. If the cognitive tests are supportive of cognitive impairment, individuals are referred to their GP for further evaluation. If dementia is diagnosed, a comprehensive geriatric assessment takes place to identify other relevant geriatric problems that need to be addressed. Furthermore, the team of GP and PN provide information and support.
GPs provide care and diagnosis as usual.Main study parameters: after 12 months both groups are compared on: 1) incident dementia (and MCI) diagnoses and 2) patient and caregiver quality of life (QoL-AD; EQ5D) and mental health (MH5; GHQ 12) and caregiver competence to care (SSCQ). The process evaluation concerns facilitating and impeding factors to the implementation of this intervention. These factors are assessed on the care provider level, the care recipient level and on the organisational level.
This study will provide insight into the diagnostic yield and the clinical effects of case finding and collaborative care for individuals with suspected cognitive impairment, compared to usual care. A process evaluation will give insight into the feasibility of this intervention.The first results are expected in the course of 2013.
NTR3389.
在初级保健环境中，痴呆症通常在疾病过程中被相对较晚地诊断出来。病例发现和积极的协作护理可能会通过澄清认知能力下降和行为改变的原因，并通过提供支持、护理计划和获得服务，对患者和非正式照顾者产生有益的影响。我们的目标是提高全科医生对痴呆症患者的识别和诊断。除了这一诊断目标外，还探讨了病例发现和随后的护理对痴呆症患者和他们的非正式照顾者的心理健康的影响。
具有过程评估的群组随机对照试验。
162 名年龄≥65 岁的个体，分布在 15 个初级保健实践中，其中全科医生怀疑有认知障碍，但没有痴呆症诊断。干预措施：病例发现和协作护理：2 名经过培训的实践护士（PNs）邀请所有怀疑有认知障碍的患者进行简短的功能和认知筛查。如果认知测试支持认知障碍，将患者转介给他们的全科医生进行进一步评估。如果诊断为痴呆症，将进行全面的老年评估，以确定需要解决的其他相关老年问题。此外，由全科医生和 PNs 组成的团队提供信息和支持。
全科医生提供常规护理和诊断。
在 12 个月后，比较两组：1）新发痴呆症（和 MCI）诊断，以及 2）患者和照顾者的生活质量（AD-QoL；EQ5D）和心理健康（GHQ-12）以及照顾者的照顾能力（SSCQ）。过程评估涉及对实施该干预措施的促进和阻碍因素的评估。这些因素在护理提供者层面、护理接受者层面和组织层面上进行评估。
这项研究将提供有关病例发现和协作护理对疑似认知障碍患者的诊断效果和临床效果的见解，与常规护理相比。过程评估将提供有关该干预措施可行性的见解。预计第一批结果将在 2013 年期间公布。
NTR3389。
