GPS Clinical Intervention for Dementia

Recruiting at 2 trial locations

Overseen By Line Guénette, Ph.D

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: CHU de Quebec-Universite Laval

Disqualifiers: Palliative care, Non-French speakers, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

400 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new model of care, called the GPS clinical intervention, to help seniors with cognitive issues, such as memory problems, manage their medications better at home. It aims to reduce unnecessary medications, maintain brain health, improve quality of life, and support independence. The care team, including nurses, pharmacists, and doctors, will collaborate closely with home care services to achieve these goals. Seniors who take prescription medications and are being evaluated for memory issues or have been diagnosed with a major neurocognitive disorder may be well-suited for this trial. As an unphased trial, this study offers a unique opportunity to contribute to innovative care solutions that could enhance independence and quality of life for seniors.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it aims to optimize your medication use. It's best to discuss your specific situation with the trial team.

What prior data suggests that this model of care is safe for seniors with cognitive disorders?

Research has shown that the GPS clinical program for dementia aims to enhance the care seniors receive at home by improving communication among healthcare professionals and reducing unnecessary medications.

Regarding safety, specific data from studies on this program is not available. However, since the GPS program is not a new drug or treatment, it does not carry the side effects typically associated with medications.

The program emphasizes teamwork and information sharing among care teams, making it a low-risk option for seniors. Its goal is to maintain mental health and quality of life by enhancing care without introducing new risks.

Although specific safety data is lacking, the program's nature suggests it is well-tolerated. It is designed to improve life without adding new health concerns. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the GPS clinical intervention for dementia because it offers a novel approach to patient care. Unlike traditional treatments that primarily focus on medication and cognitive therapies, the GPS intervention integrates technology to enhance the everyday management of dementia. By using GPS tracking, caregivers can better monitor and support patients, potentially improving safety and independence. This method could revolutionize how we manage dementia, offering a more personalized and proactive care strategy.

What evidence suggests that the GPS clinical intervention is effective for dementia?

Research has shown that collaboration among doctors, nurses, and pharmacists can benefit people with dementia by improving health outcomes and reducing costs. Studies have found that this teamwork simplifies medication management and enhances home care. In this trial, some participants will join the group exposed to the GPS clinical intervention, which involves such collaborative care. Family doctors, or general practitioners (GPs), play a crucial role in early dementia detection and ensuring appropriate patient care. By reducing unnecessary medications, this approach aims to protect brain health and enhance life quality for older adults. Overall, these methods have demonstrated positive effects on both patients and their caregivers. ^{3 6 7 8 9}

Who Is on the Research Team?

Line Guénette, Ph.D

Principal Investigator

CHU de Québec-Université Laval, Laval University

Are You a Good Fit for This Trial?

This trial is for seniors aged 65 or older who have been diagnosed with cognitive impairment or major neurocognitive disorder (MCND) within the last year and are receiving home care. They must be referred to a memory clinic or pharmacist, taking prescription medications, and able to answer questionnaires in French without help.

Inclusion Criteria

Having been diagnosed with cognitive impairment within the last year

With MCND and followed up at home

You have been referred to a clinic that specializes in memory-related issues.

Exclusion Criteria

Seniors in palliative care

Unable to answer questionnaires in French without a caregiver.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive the GPS intervention aimed at optimizing pharmacotherapy and supporting autonomy

6 months

Regular visits with FMG team

Follow-up

Participants are monitored for changes in quality of life, treatment burden, and medication use

6 months

2 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• GPS clinical intervention

Trial Overview

The GPS clinical intervention being tested aims to optimize medication use among seniors with MCND at home. It involves knowledge sharing sessions between nurses, pharmacists, doctors in Family Medicine Groups (FMGs), and collaboration with home care service teams.

How Is the Trial Designed?

Group I: Exposed FMGs to GPS intervention Experimental Treatment 1 Intervention

Patients who are followed by FMGs exposed to the GPS intervention. They will receive the GPS intervention.

Group II: Non exposed FMGs to GPS intervention Active Control 1 Intervention

Patients who are part of the FMGs not exposed to the GPS intervention. They will receive the usual care and services.

Who Is Running the Clinical Trial?

CHU de Quebec-Universite Laval

Lead Sponsor

Trials

177

Recruited

110,000+

Ciusss de L'Est de l'Île de Montréal

Collaborator

Trials

81

Recruited

6,400+

CISSS de Chaudière-Appalaches

Collaborator

Trials

9

Recruited

16,500+

CIUSSS du Nord-de-l'Île-de-Montréal

Collaborator

Trials

4

Recruited

820+

Fonds de la Recherche en Santé du Québec

Collaborator

Trials

84

Recruited

46,700+

Published Research Related to This Trial

The study found that the introduction of the Quality and Outcomes Framework (QOF) Depression Indicators did not significantly change the pattern of referrals from primary care to dedicated dementia clinics, suggesting that the referral process remains largely unchanged.

A low proportion of patients referred for dementia evaluation actually receive a dementia diagnosis, with many potentially suffering from depressive disorders instead, highlighting the need for better differentiation between dementia and depression in primary care settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Have Quality and Outcomes Framework Depression Indicators changed referrals from primary care to a dedicated memory clinic? Fearn, S., Larner, AJ.[2021]

A study involving 102 French general practitioners revealed that their confidence and adherence to national recommendations significantly influence their practices in assessing and managing dementia.

Many GPs reported feeling less confident in providing information about dementia resources, and a common reason for underdiagnosis was the perceived limited effectiveness of available drug therapies, highlighting a need for improved training and support in dementia care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Description of general practitioners' practices when suspecting cognitive impairment. Recourse to care in dementia (Recaredem) study. Harmand, MG., Meillon, C., Rullier, L., et al.[2019]

A survey of 129 GPs and 239 neurologists/psychiatrists in Germany revealed a generally positive attitude towards the care of dementia patients, with both groups valuing early diagnosis and the importance of social support for patients and caregivers.

Despite some differences in the use of cognitive tests and perceived competence in treatment, the overall approach to managing cognitively impaired patients was similar between GPs and specialists, indicating a unified front in dementia care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[The management of dementia patients from the point of view of office-based general practitioners (GPs) and specialists--the results of an empirical investigation]. Kaduszkiewicz, H., Wiese, B., van den Bussche, H.[2019]

The study analyzed data from over 31,000 dementia patients and found that better performance in the Quality and Outcomes Framework (QOF) dementia review is linked to a lower risk of being placed in a care home after an emergency hospital admission, particularly for ambulatory care sensitive conditions.

Overall, 19% of dementia patients were discharged to care homes after hospital admission, highlighting the importance of coordinated care and support for patients and their caregivers to potentially prevent unnecessary long-term placements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Risk of Care Home Placement following Acute Hospital Admission: Effects of a Pay-for-Performance Scheme for Dementia. Kasteridis, P., Mason, A., Goddard, M., et al.[2022]

A total of 104 GPs participated in 39 peer-facilitated workshops, which significantly improved their self-reported knowledge and confidence in providing dementia care.

The workshops were well-received, with GPs appreciating the relevance of the content and the peer-facilitation approach, suggesting that similar educational methods could benefit GPs in managing other complex chronic conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The development and evaluation of peer-facilitated dementia workshops in general practice. Foley, T., Jennings, A., Boyle, S., et al.[2022]

A qualitative evaluation of a facilitator programme for GPs on dementia revealed that motivation to participate was driven by the desire for neutral knowledge, dialogue with colleagues, and the facilitator's approach, highlighting the importance of personal connection in educational outreach.

Barriers to participation included a lack of understanding of the programme's relevance and goals, suggesting that improving the introduction and clarity of the programme could enhance GP engagement and effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Motivation and barriers to the use of facilitator visits in general practice]. Dalsgaard, T., Rosendal, M.[2015]

General practitioners can diagnose dementia without routine imaging, as the risk of missing treatable causes is low if no abnormalities are found during clinical investigations.

Psycho-social interventions are beneficial for dementia patients and their caregivers, helping to delay nursing home admissions, highlighting the importance of collaboration among local care providers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Summary of Dutch College of General Practitioners' (NHG) practice guideline 'Dementia']. Luning-Koster, M., Perry, M., Moll van Charante, EP., et al.[2015]

A national survey of general practitioners in Malta revealed that while many GPs feel incompetent in diagnosing dementia, only a few prefer to refer patients to specialists, indicating a gap in confidence and practice.

The study found that GPs' prescribing practices for dementia medications varied significantly based on their years of experience and the disease's progression, highlighting the need for ongoing education to improve dementia management in primary care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Practices in diagnosis, disclosure and pharmacotherapeutic management of dementia by general practitioners--a national survey. Caruana-Pulpan, O., Scerri, C.[2018]

General Practitioners (GPs) in Ireland recognize the complexity of dementia care and emphasize the need for improved education and training to enhance the quality of care provided in primary settings.

To effectively implement community-based dementia care, GPs advocate for better financial resources and a restructured service delivery system, highlighting the importance of addressing disparities in care and promoting public awareness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving the Quality of Dementia Care in General Practice: A Qualitative Study. Bourque, M., Foley, T.[2020]

Citations

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pmc.ncbi.nlm.nih.gov

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Clinical Outcomes and Cost-Effectiveness of Collaborative ...

This study adds evidence for the effectiveness and cost-effectiveness of a 6-month collaborative care intervention for people living with ...

2.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC6104761/

Effectiveness of a peer-mediated educational intervention ...

GPs' detection and management of dementia have been addressed in several educational interventions with varying success. Large seminar-based ...

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bmcprimcare.biomedcentral.com

bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02566-3

General practitioners' perspectives on lifestyle interventions ...

General practitioners (GPs) play a crucial role in identifying cognitive impairment and dementia and providing post-diagnostic care.

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onlinelibrary.wiley.com

onlinelibrary.wiley.com/doi/full/10.1002/gps.70054

Effectiveness of Interventions to Support Carers of People ...

Meta-analysis revealed statistically significant medium-to-large intervention effects on three key carer outcomes—perceived burden, depression, ...

5.

sciencedirect.com

sciencedirect.com/science/article/pii/S127977072302287X

Cost-effectiveness of post-diagnosis treatment in dementia ...

The study will provide an answer to whether follow-up of dementia patients can best be done in specialised outpatient memory clinics or in primary care ...

6.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC11290024/

Implementing global positioning system trackers for people ...

GPS trackers may reduce emotional distress and risk of physical harm by assisting family members to find relatives much quicker, reducing the ...

7.

sciencedirect.com

sciencedirect.com/science/article/pii/S1041610224020738

Ethical aspects of using GPS for tracking people with ...

The lack of ethical consensus on the use of GPS for people with dementia underlines the need for clearer policies and practical guidelines.

8.

jamanetwork.com

jamanetwork.com/journals/jamanetworkopen/fullarticle/2820840

Clinical Outcomes and Cost-Effectiveness of Collaborative ...

People living with dementia receiving CDCM had significantly higher odds of taking antidementia drugs after 12 months (adjusted odds ratio [AOR] ...

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tandfonline.com

tandfonline.com/doi/full/10.1080/15228835.2025.2528781

Systematic Literature Review of Wandering Prevention ...

A total of 12 studies were found to be eligible after screening, encompassing various aspects of dementia care technologies and their impact on wandering ...