Effectiveness of a peer-mediated educational intervention in improving general practitioner diagnostic assessment and management of dementia: a cluster randomised controlled trial
| Autor: | Henry Brodaty, Nerida Paterson, Peter B Disler, Natasha Weaver, John Marley, Graeme Horton, Karen E. Mate, Susan Goode, Parker Magin, Jane Gunn, Dimity Pond, Nigel Stocks |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
Primary care Sensitivity and Specificity Peer Group 03 medical and health sciences primary care 0302 clinical medicine Quality of life (healthcare) Nursing Double-Blind Method General Practitioners Intervention (counseling) medicine Dementia Humans 030212 general & internal medicine Cluster randomised controlled trial Referral and Consultation Aged Aged 80 and over Clinical Audit 030214 geriatrics business.industry geriatric medicine Depression Research Communication Australia Peer group General Medicine Middle Aged medicine.disease 3. Good health Caregivers Patient Satisfaction Quality of Life Diagnostic assessment Education Medical Continuing Female Clinical Competence Clinical competence business General practice / Family practice |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| Popis: | ObjectiveTest effectiveness of an educational intervention for general practitioners (GPs) on quality of life and depression outcomes for patients.DesignDouble-blind, cluster randomised controlled trial.SettingGeneral practices in Australia between 2007 and 2010.ParticipantsGeneral 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).InterventionsA 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 measuresPrimary 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.ResultsThe 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).ConclusionPractice-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 numberACTRN12607000117415; Pre-results. |
| Databáze: | OpenAIRE |
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