Primary dementia care based on the individual needs of the patient: study protocol of the cluster randomized controlled trial, DemStepCare

BMC Geriatrics

Michael Jansky¹  Julian Wangler¹  Marie Kockläuner²  Alexandra Wuttke-Linnemann³  Katharina Geschke³  Andreas Fellgiebel³  Dominikus Stelzer⁴  Erika Graf⁴  Klaus Kaier⁴  Harald Binder⁴  Isabella Bablok⁵  Erik Farin⁵  Michael Löhr⁶  Michael Schulz⁶ 

[1] Center for General and Geriatric Medicine, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany;Department of Pharmacy, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany;Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany;Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany;Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany;Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany;Landschaftsverband Westfalen-Lippe, Hospital Gütersloh, Gütersloh, Germany;Diakonie University of Applied Sciences, Bielefeld, Germany;

关键词: Dementia;    Primary care;    Case management;    Risk assessment;    Multi-professional team;    Caregivers;    Evaluation;    Cluster randomized controlled trial;   

DOI  :  10.1186/s12877-021-02114-z

来源: Springer

【 摘 要 】

BackgroundMost people with dementia (PwD) are cared for at home, with general practitioners (GPs) playing a key part in the treatment. However, primary dementia care suffers from a number of shortcomings: Often, diagnoses are made too late and therapies by GPs do not follow the guidelines. In cases of acute crises, PwD are too often admitted to hospital with adverse effects on the further course of the disease.The aim of this study is to implement and evaluate a new GP-based, complex dementia care model, DemStepCare. DemStepCare aims to ensure demand-oriented, stepped care for PwD and their caregivers.Methods/designIn a cluster randomized controlled trial, the care of PwD receiving a complex intervention, where the GP is supported by a multi-professional team, is compared to (slightly expanded) usual care.GPs are clustered by GP practice, with 120 GP practices participating in total. GP practices are randomized to an intervention or a control group. 800 PwD are to be included per group. Recruitment takes place in Rhineland-Palatinate, Germany. In addition, a second control group with at least 800 PwD will be formed using aggregated routine data from German health insurance companies. The intervention comprises the training of GPs, case management including repeated risk assessment of the patients’ care situation, the demand-oriented service of an outpatient clinic, an electronic case record, external medication analyses and a link to regional support services. The primary aims of the intervention are to positively influence the quality of life for PwD, to reduce the caregivers’ burden, and to reduce the days spent in hospital. Secondary endpoints address medication adequacy and GPs’ attitudes and sensitivity towards dementia, among others.DiscussionThe GP-based dementia care model DemStepCare is intended to combine a number of promising interventions to provide a complex, stepped intervention that follows the individual needs of PwD and their caregivers. Its effectiveness and feasibility will be assessed in a formative and a summative evaluation.Trial registrationGerman Register of Clinical Trials (Deutsches Register Klinischer Studien, DRKS), DRKS00023560. Registered 13 November 2020 - Retrospectively registered. HTML&TRIAL_ID=DRKS00023560.

【 授权许可】

CC BY