GPS Clinical Intervention for Dementia

Recruiting at 1 trial location

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

Trial Summary

What is the purpose of this trial?

The model of care tested in the GPS project aims to optimize pharmacotherapy for seniors undergoing cognitive assessment or suffering from major neurocognitive disorder (MCND) at home. The goal is to reduce polymedication, inappropriate medications and the treatment burden of seniors and to maintain their cognitive health, quality of life and autonomy. The intervention will include knowledge exchange sessions with nurses, pharmacists, and doctors in FMGs, and increased collaboration between these professionals and home care services teams. Other goal is to increase the satisfaction of the seniors, their families, and the professionals involved in the GPS project.

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 data supports the effectiveness of the GPS clinical intervention treatment for dementia?

The research suggests that psycho-social interventions, which may be part of the GPS clinical intervention, have a positive effect on dementia patients and their caregivers, potentially delaying the need for nursing home admission. ^{1 2 3 4 5}

How does the GPS Clinical Intervention treatment for dementia differ from other treatments?

The GPS Clinical Intervention for dementia is unique because it focuses on psycho-social interventions, which have been shown to positively impact patients and their caregivers, potentially delaying the need for nursing home admission. Unlike some other treatments, it does not involve routine imaging or the prescription of cholinesterase inhibitors or memantine, which are not recommended by general practitioners. ^{2 6 7 8 9}

Research Team

Line Guénette, Ph.D

Principal Investigator

CHU de Québec-Université Laval, Laval University

Eligibility Criteria

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

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)

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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 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 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 (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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Have Quality and Outcomes Framework Depression Indicators changed referrals from primary care to a dedicated memory clinic? [2021]

2. Netherlands pubmed.ncbi.nlm.nih.gov

[Summary of Dutch College of General Practitioners' (NHG) practice guideline 'Dementia']. [2015]

3. England pubmed.ncbi.nlm.nih.gov

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

4. Germany 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]. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Risk of Care Home Placement following Acute Hospital Admission: Effects of a Pay-for-Performance Scheme for Dementia. [2022]

6. England pubmed.ncbi.nlm.nih.gov

The development and evaluation of peer-facilitated dementia workshops in general practice. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Description of general practitioners' practices when suspecting cognitive impairment. Recourse to care in dementia (Recaredem) study. [2019]

8. Denmark pubmed.ncbi.nlm.nih.gov

[Motivation and barriers to the use of facilitator visits in general practice]. [2015]

9. Switzerland pubmed.ncbi.nlm.nih.gov

Improving the Quality of Dementia Care in General Practice: A Qualitative Study. [2020]