Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK.
Trials. 2013 Nov 20;14:397. doi: 10.1186/1745-6215-14-397.
Early diagnosis of dementia is important because this allows those with dementia and their families to engage support and plan ahead. However, dementia remains underdetected and suboptimally managed in general practice. Our objective was to test the effect of a workplace-based tailored educational intervention developed for general practice on the clinical management of people with dementia.
The tailored educational intervention was tested in an unblinded cluster randomized controlled trial with a pre/post-intervention design, with two arms: usual/normal care control versus educational intervention. The primary outcome measure was an increase in the proportion of patients with dementia who received at least two documented dementia-specific management reviews per year. Case identification was a secondary outcome measure.
23 practices in South-East England participated. A total of 1,072 patients with dementia (intervention: 512, control: 560) had information in their medical records showing the number of reviews within 12 months (or a proportion of) before intervention or randomization and within 12 months (or a proportion of) after. The mean total number of dementia management reviews after the educational intervention for people with dementia was 0.89 (SD 1.09; minimum 0; median 1; maximum 8) compared with 0.89 (SD 0.92; minimum 0; median 1; maximum 4) before intervention. In the control group prior to randomization the mean total number of dementia management reviews was 1.66 (SD 1.87; minimum 0; median 1; maximum 12) and in the period after randomization it was 1.56 (SD 1.79; minimum 0; median 1; maximum 11). Case detection rates were unaffected. The estimated incidence rate ratio for intervention versus control group was 1.03 (P = 0.927, 95% CI 0.57 to 1.86).
The trial was timely, coinciding with financial incentives for dementia management in general practice (through the Quality Outcomes Framework); legal imperatives (in the form of the Mental Capacity Act 2005); policy pressure (The National Dementia Strategy 2009); and new resources (such as dementia advisors) that increased the salience of dementia for general practitioners. Despite this the intervention did not alter the documentation of clinical management of patients with dementia in volunteer practices, nor did it increase case identification.
NCT00866099/Clinical Trials.
早期诊断痴呆症非常重要，因为这可以让痴呆症患者及其家人获得支持并提前规划。然而，在一般实践中，痴呆症的诊断仍然不足，管理也不理想。我们的目的是测试为一般实践定制的基于工作场所的教育干预对痴呆症患者临床管理的影响。
该定制教育干预在一项未设盲的、以干预前后设计为基础的、有两个组的非随机对照试验中进行了测试：常规/常规护理对照组与教育干预组。主要结果衡量标准是每年至少进行两次记录在案的痴呆症具体管理评估的患者比例增加。病例识别是次要结果衡量标准。
英格兰东南部的 23 个实践参与了研究。共有 1072 名痴呆症患者（干预组：512 名，对照组：560 名）的医疗记录中有信息显示在干预前或随机分组前 12 个月内（或比例）和干预后 12 个月内（或比例）进行的评估次数。接受教育干预后的痴呆症患者的平均总痴呆症管理评估次数为 0.89（SD 1.09；最小 0；中位数 1；最大 8），而干预前为 0.89（SD 0.92；最小 0；中位数 1；最大 4）。在对照组中，随机分组前的平均总痴呆症管理评估次数为 1.66（SD 1.87；最小 0；中位数 1；最大 12），随机分组后为 1.56（SD 1.79；最小 0；中位数 1；最大 11）。病例检出率没有受到影响。干预组与对照组的发病率比值估计为 1.03（P=0.927，95%CI 0.57 至 1.86）。
该试验恰逢一般实践中痴呆症管理的财政激励措施（通过质量结果框架）、法律要求（以 2005 年《精神能力法案》的形式）、政策压力（2009 年《国家痴呆症战略》）以及增加一般执业医生对痴呆症的关注的新资源（如痴呆症顾问）。尽管如此，该干预措施并未改变志愿者实践中痴呆症患者临床管理的记录，也没有增加病例的识别。
NCT00866099/临床试验。
