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首页> 外文期刊>Trials >Evidence-based interventions in dementia: A pragmatic cluster-randomised trial of an educational intervention to promote earlier recognition and response to dementia in primary care (EVIDEM-ED)
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Evidence-based interventions in dementia: A pragmatic cluster-randomised trial of an educational intervention to promote earlier recognition and response to dementia in primary care (EVIDEM-ED)

机译：老年痴呆症的循证干预：一项实用的教育干预干预研究，旨在促进对初级保健中老年痴呆症的早期认识和应对（EVIDEM-ED）

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Background The National Dementia Strategy seeks to enhance general practitioners' diagnostic and management skills in dementia. Early diagnosis in dementia within primary care is important as this allows those with dementia and their family care networks to engage with support services and plan for the future. There is, however, evidence that dementia remains under-detected and sub-optimally managed in general practice. An earlier unblinded, cluster randomised controlled study tested the effectiveness of educational interventions in improving detection rates and management of dementia in primary care. In this original trial, a computer decision support system and practice-based educational workshops were effective in improving rates of detecting dementia although not in changing clinical management. The challenge therefore is to find methods of changing clinical management. Our aim in this new trial is to test a customised educational intervention developed for general practice, promoting both earlier diagnosis and concordance with management guidelines. Design/Method The customised educational intervention combines practice-based workshops and electronic support material. Its effectiveness will be tested in an unblinded cluster randomised controlled trial with a pre-post intervention design, with two arms; normal care versus the educational intervention. Twenty primary care practices have been recruited with the aim of gaining 200 patient participants. We will examine whether the intervention is effective, pragmatic and feasible within the primary care setting. Our primary outcome measure is an increase in the proportion of patients with dementia who receive at least two dementia-specific management reviews per year. We will also examine important secondary outcomes such as practice concordance with management guidelines and benefits to patients and carers in terms of quality of life and carer strain. Discussion The EVIDEM-ED trial builds on the earlier study but the intervention is different in that it is specifically customised to the educational needs of each practice. If this trial is successful it could have implications for the implementation of the National Dementia Strategy. Trial registration NCT00866099
机译：背景信息《国家痴呆症战略》旨在提高全科医生对痴呆症的诊断和管理技能。在初级保健中对痴呆症进行早期诊断非常重要，因为这可以使患有痴呆症的人及其家庭保健网络参与支持服务并为未来做计划。但是，有证据表明，在一般实践中，痴呆症的检出率仍未得到很好的检测，并且未达到最佳状态。一项较早的无盲，整群随机对照研究测试了教育干预措施在提高初级保健中痴呆症的检出率和管理中的有效性。在该原始试验中，计算机决策支持系统和基于实践的教育研讨会有效地提高了痴呆症的检出率，但并未改变临床管理。因此，挑战在于寻找改变临床管理的方法。我们在此新试验中的目的是测试针对一般实践开发的定制教育干预措施，以促进早期诊断和与管理指南的一致性。设计/方法定制的教育干预措施结合了基于实践的研讨会和电子支持材料。其有效性将在一项无盲的，有前后干预设计，两组干预的随机对照试验中进行测试;正常护理与教育干预。已经招募了20种初级保健实践，目的是吸引200名患者参加。我们将检查该干预措施在基层医疗机构中是否有效，务实且可行。我们的主要结局指标是每年至少接受两次针对痴呆症的管理评估的痴呆症患者的比例增加。我们还将研究重要的次要结局，例如与管理指南保持一致的实践以及就生活质量和护理压力而言给患者和护理人员带来的好处。讨论EVIDEM-ED试验建立在较早的研究基础上，但干预措施不同，因为它是针对每种实践的教育需求专门定制的。如果这项试验成功，可能会对《国家痴呆症战略》的实施产生影响。试用注册NCT00866099

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