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General practice / Family practice
Research
Effectiveness of a peer-mediated educational intervention in improving general practitioner diagnostic assessment and management of dementia: a cluster randomised controlled trial
  1. Dimity Pond1,
  2. Karen Mate2,
  3. Nigel Stocks3,
  4. Jane Gunn4,
  5. Peter Disler5,
  6. Parker Magin1,
  7. John Marley1,
  8. Nerida Paterson1,
  9. Graeme Horton1,
  10. Susan Goode1,
  11. Natasha Weaver1,
  12. Henry Brodaty6
  1. 1 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
  2. 2 School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
  3. 3 Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
  4. 4 Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
  5. 5 School of Rural Health, Monash University, Bendigo, Victoria, Australia
  6. 6 Dementia Centre for Research Collaboration and the Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dimity Pond; Dimity.Pond{at}newcastle.edu.au

Abstract

Objective Test effectiveness of an educational intervention for general practitioners (GPs) on quality of life and depression outcomes for patients.

Design Double-blind, cluster randomised controlled trial.

Setting General practices in Australia between 2007 and 2010.

Participants General practices were randomly allocated to the waitlist (n=37) or intervention (n=66) group, in a ratio of 1:2. A total of 2030 (1478 intervention; 552 waitlist) community-dwelling participants aged 75 years or older were recruited via 168 GPs (113 intervention; 55 waitlist).

Interventions A practice-based academic detailing intervention led by a peer educator that included: (1) training in use of the GP assessment of cognition dementia screening instrument; (2) training in diagnosis and management based on Royal Australian College of General Practitioners Dementia Guidelines; (3) addressing GPs’ barriers to dementia diagnosis; and (4) a business case outlining a cost-effective dementia assessment approach.

Outcome measures Primary outcome measures were patient quality of life and depression; secondary outcome measures were: (1) sensitivity and specificity of GP identification of dementia; (2) referral to medical specialists and/or support services; (3) patient satisfaction with care; and (4) carer quality of life, depression and satisfaction with care.

Results The educational intervention had no significant effect on patient quality of life or depression scores after 12 months. There were however improvements in secondary outcome measures including sensitivity of GP judgement of dementia (p=0.002; OR 6.0, 95% CI 1.92 to 18.73), satisfaction with GP communication for all patients (p=0.024; mean difference 2.1, 95% CI 0.27 to 3.93) and for patients with dementia (p=0.007; mean difference 7.44, 95% CI 2.02 to 12.86) and enablement of carers (p=0.0185; mean difference 24.77, 95% CI 4.15 to 45.40).

Conclusion Practice-based academic detailing did not improve patient quality of life or depression scores but did improve detection of dementia in primary care and patient satisfaction with GP communication.

Trial registration number ACTRN12607000117415; Pre-results.

  • geriatric medicine
  • dementia
  • primary care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2017-021125

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    Footnotes

    • Contributors All authors had full access to data (including statistical reports and tables) and take responsibility for the integrity of the data and accuracy of the data analysis. DP conceived and developed this study, drafted the manuscript, had overall management of the project and is guarantor. KM assisted in study design, data management and statistical analysis and drafted the manuscript. NS assisted in study design and managed operations at the Adelaide site. JG assisted in study design and managed operations at the Melbourne site. JM assisted in study design. PD assisted in study design and managed operations at the Bendigo site. PM assisted in study design and drafted the manuscript. NP and GH developed the educational intervention and assisted in study design. SG assisted in study design and provided project management and drafted the manuscript. NW performed the statistical analyses. HB assisted in study design and managed operations at the Sydney site. All authors read and approved the final manuscript.

    • Funding This project was funded by the Australian National Health and Medical Research Council (Grant ID #351220 and #510745), Beyond Blue: The National Depression Initiative and the Australian Government Department of Health and Ageing (Project # ITA195/0506). The authors analysed results and prepared this manuscript independently of the funding body.

    • Disclaimer The funding body did not have a role in the study design, the collection, analysis and interpretation of data or the writing of the article and the decision to submit it for publication.

    • Competing interests DP and HB have sat on advisory boards for Pfizer, Novartis, Janssen, Lundbeck and Nutricia and been speakers sponsored by Pfizer, Novartis (HB only) and Janssen (HB only). HB has been an investigator on projects funded by Pfizer, Novartis, Janssen, Lundbeck, Lilly and Sanofi and acted as a consultant for Merck and Baxter.

    • Patient consent Not required.

    • Ethics approval Ethics approval was sought and granted initially from the Newcastle University Human Research Ethics Committee (Approval No. H-151-1205), and following this, from the appropriate Ethics Committees at each site. All participants gave written informed consent.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data available.