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Full-Length Research Report

Tablet-Based Outpatient Care for People With Dementia

The DemTab Study Protocol

Published Online:https://doi.org/10.1024/1662-9647/a000210

Abstract. Most people with dementia (PwD) are treated on an outpatient basis, predominantly by general practitioners (GPs). This article provides a detailed protocol of a study aimed at developing and evaluating a tablet-based intervention to improve outpatient dementia care by fostering guideline-based treatment. A cluster-randomized controlled trial with an intervention group (tablet-based intervention) and a control group (treatment as usual plus information handbook) will be conducted. Clusters will be randomized at GP level. Primary outcome is defined as adherence to dementia guideline recommendations after 9 months. Secondary outcomes include various health outcomes assessed in PwD (e.g., quality of life) and informal caregivers (e.g., caregiver burden). Outcomes will be analyzed by an intention-to-treat analysis and using mixed models.

References

  • Albrecht, M., & Sander, M. (2015). Demenzversorgung aus sektorenübergreifender Sicht, Patientenbezogene Auswertung von Daten aus der Gesetzlichen Krankenversicherung (BARMER GEK Krankenkasse) der Jahre 2008 bis 2010. Retrieved from https://www.versorgungsatlas.de/fileadmin/ziva_docs/57/VA-57-2015-Kurzbericht-final.pdf First citation in articleGoogle Scholar

  • Alzheimer’s Association. (2017). 2017 Alzheimer’s disease facts and figures (1552–5260). Retrieved from http://www.sciencedirect.com/science/article/pii/S1552526017300511 First citation in articleGoogle Scholar

  • Bohlken, J., Peiseler, G. J., & Kohlmann, T. (2015). Ambulante Demenzversorgung–Wer soll es machen? Eine Befragung von 400 Hausärzten [Service Provision for Dementia Patients in the Outpatient Setting – Who Should be Responsible? A Survey of 400 Primary Care Physicians]. Aktuelle Neurologie, 42(05), 256–259. https://doi.org/10.1055/s-0035-1550016 First citation in articleCrossrefGoogle Scholar

  • Bullinger, M., Kirchberger, I., & Ware, J. (1995). Der deutsche SF-36 Health Survey Übersetzung und psychometrische Testung eines krankheitsübergreifenden Instruments zur Erfassung der gesundheitsbezogenen Lebensqualität. Zeitschrift für Gesundheitswissenschaften = Journal of public health, 3(1), 21. https://doi.org/10.1007/BF02959944 First citation in articleCrossrefGoogle Scholar

  • Bussche, H. V. D., Wiese, B., Schön, G., Eisele, M., Koller, D., Steinmann, S., & Kaduszkiewicz, H. (2013). Die vertragsärztliche Versorgung von Patienten mit Demenz im Spiegel von Abrechnungsdaten einer GKV-Kasse. Zeitschrift für Allgemeinmedizin, 89, 55–60. https://doi.org/10.3238/zfa.2013.0055-0060 First citation in articleGoogle Scholar

  • Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44(12), 2308–2314. https://doi.org/10.1212/WNL.44.12.2308 First citation in articleCrossrefGoogle Scholar

  • Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde. (2016). S3-Leitlinie Demenzen [S3 Guideline Dementia]. Leitlinien für Diagnostik und Therapie in der Neurologie [Guidelines for Diagnostics and Therapy in Neurology]. (Langversion – Januar 2016). Retrieved from https://www.dgppn.de/_Resources/Persistent/ade50e44afc7eb8024e7f65ed3f44e995583c3a0/S3-LL-Demenzen-240116.pdf First citation in articleGoogle Scholar

  • Downs, M., Cook, A., Rae, C., & Collins, K. E. (2000). Caring for patients with dementia: The GP perspective. Aging and Mental Health, 4, 301–304. https://doi.org/10.1080/713649963 First citation in articleCrossrefGoogle Scholar

  • Dreier, A., & Hoffmann, W. (2013). Dementia Care Manager für Patienten mit Demenz. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz, 56, 1398–1409. https://doi.org/10.1007/s00103-013-1796-0 First citation in articleCrossrefGoogle Scholar

  • Eichler, T., Thyrian, J. R., Fredrich, D., Köhler, L., Wucherer, D., Michalowsky, B., … Hoffmann, W. (2014). The benefits of implementing a computerized Intervention Management System (IMS) on delivering integrated dementia care in the primary care setting. International Psychogeriatrics, 26, 1377–1385. https://doi.org/10.1017/S1041610214000830 First citation in articleCrossrefGoogle Scholar

  • Foley, T., Boyle, S., Jennings, A., & Smithson, W. H. (2017). “We’re certainly not in our comfort zone”: A qualitative study of GPs’ dementia-care educational needs. BMC Family Practice, 18(1), 66. https://doi.org/10.1186/s12875-017-0639-8 First citation in articleCrossrefGoogle Scholar

  • Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6 First citation in articleCrossrefGoogle Scholar

  • Gauggel, S., & Birkner, B. (1999). Validität und Reliabilität einer deutschen Version der Geriatrischen Depressionsskala (GDS) [Validity and reliability of a German version of the Geriatric Depression Scale (GDS)]. Zeitschrift für Klinische Psychologie, 28(1), 18–27. https://doi.org/10.1026//0084-5345.28.1.18 First citation in articleLinkGoogle Scholar

  • Heidenblut, S., & Zank, S. (2010). Entwicklung eines neuen Depressionsscreenings für den Einsatz in der Geriatrie. Zeitschrift für Gerontologie und Geriatrie, 43(3), 170–176. https://doi.org/10.1007/s00391-009-0067-z First citation in articleCrossrefGoogle Scholar

  • Herdman, M., Gudex, C., Lloyd, A., Janssen, M., Kind, P., Parkin, D., … Badia, X. (2011). Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D–5L). Quality of Life Research, 20(10), 1727–1736. https://doi.org/10.1007/s11136-011-9903-x First citation in articleCrossrefGoogle Scholar

  • Heuschmann, P. U., Kolominsky-Rabas, P. L., Nolte, C. H., Hünermund, G., Ruf, H. U., Laumeier, I., … Berger, K. (2005). Untersuchung der Reliabilität der deutschen Version des Barthel-Index sowie Entwicklung einer postalischen und telefonischen Fassung für den Einsatz bei Schlaganfall-Patienten [The Reliability of the German Version of the Barthel-Index and the Development of a Postal and Telephone Version for the Application on Stroke Patients]. Fortschritte der Neurologie-Psychiatrie, 73(02), 74–82. https://doi.org/10.1055/s-2004-830172 First citation in articleCrossrefGoogle Scholar

  • Jeschke, E., Ostermann, T., Vollmar, H. C., Tabali, M., Schad, F., & Matthes, H. (2011). Prescribing patterns in dementia: A multicentre observational study in a German network of CAM physicians. BMC Neurology, 11(1), 99. https://doi.org/10.1186/1471-2377-11-99 First citation in articleCrossrefGoogle Scholar

  • Kaduszkiewicz, H., Wiese, B., & van den Bussche, H. (2008). Self-reported competence, attitude and approach of physicians toward patients with dementia in ambulatory care: Results of a postal survey. BMC Health Services Research, 8(1), 54. https://doi.org/10.1186/1472-6963-8-54 First citation in articleCrossrefGoogle Scholar

  • Karanicolas, P. J., Farrokhyar, F., & Bhandari, M. (2010). Practical tips for surgical research: Blinding: who, what, when, why, how? Canadian Journal of Surgery, 53, 345–348. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20858381 First citation in articleGoogle Scholar

  • Karrer, K., Glaser, C., Clemens, C., & Bruder, C. (2009). Technikaffinität erfassen–der Fragebogen TA-EG. Der Mensch im Mittelpunkt technischer Systeme, 8, 196–201. First citation in articleGoogle Scholar

  • Koch, T., Iliffe, S. & The E.-E. D. p. (2010). Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: A systematic review. BMC Family Practice, 11(1), 52. https://doi.org/10.1186/1471-2296-11-52 First citation in articleCrossrefGoogle Scholar

  • Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9(3), 179–186. First citation in articleCrossrefGoogle Scholar

  • Leve, V., Ilse, K., Ufert, M., Wilm, S., & Pentzek, M. (2017). Driving and dementia: An issue for general practice?!. Zeitschrift für Gerontologie und Geriatrie, 50(Suppl 2), 55–62. https://doi.org/10.1007/s00391-017-1234-2 First citation in articleCrossrefGoogle Scholar

  • Logsdon, R. G., Gibbons, L. E., McCurry, S. M., & Teri, L. (2002). Assessing Quality of Life in Older Adults With Cognitive Impairment. Psychosomatic Medicine, 64(3), 510–519. First citation in articleCrossrefGoogle Scholar

  • Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., … Mukadam, N. (2017). Dementia prevention, intervention, and care. The Lancet, 390(10113), 2673–2734. https://doi.org/110.1016/S0140-6736(17)31363-6 First citation in articleCrossrefGoogle Scholar

  • Meiland, F., Innes, A., Mountain, G., Robinson, L., van der Roest, H., García-Casal, J. A., … Franco-Martin, M. (2017). Technologies to support community-dwelling persons with dementia: A position paper on issues regarding development, usability, effectiveness and cost-effectiveness, deployment, and ethics. JMIR Rehabilitation and Assistive Technologies, 4(1), e1. https://doi.org/10.2196/rehab.6376 First citation in articleCrossrefGoogle Scholar

  • Mitchell, A. J., Meader, N., & Pentzek, M. (2011). Clinical recognition of dementia and cognitive impairment in primary care: A meta-analysis of physician accuracy. Acta Psychiatrica Scandinavica, 124, 165–183. https://doi.org/10.1111/j.1600-0447.2011.01730.x First citation in articleCrossrefGoogle Scholar

  • Murphy, K., O’Connor, D. A., Browning, C. J., French, S. D., Michie, S., Francis, J. J., … Green, S. E. (2014). Understanding diagnosis and management of dementia and guideline implementation in general practice: A qualitative study using the theoretical domains framework. Implementation Science, 9(1), 31. https://doi.org/10.1186/1748-5908-9-31 First citation in articleCrossrefGoogle Scholar

  • National Collaborating Centre for Mental Health. (2007). National Institute for Health and Clinical Excellence: Guidance. Dementia: A NICE-SCIE guideline on supporting people with dementia and their carers in health and social care. Leicester, UK: British Psychological Society, The British Psychological Society & The Royal College of Psychiatrists. First citation in articleGoogle Scholar

  • Olafsdottir, M., Foldevi, M., & Marcusson, J. (2001). Dementia in primary care: Why the low detection rate? Scandinavian Journal of Primary Health Care, 19, 194–198. https://doi.org/10.1080/028134301316982469 First citation in articleCrossrefGoogle Scholar

  • Pentzek, M., Abholz, H. H., Ostapczuk, M., Altiner, A., Wollny, A., & Fuchs, A. (2009). Dementia knowledge among general practitioners: First results and psychometric properties of a new instrument. International Psychogeriatrics, 21, 1105–1115. https://doi.org/10.1017/s1041610209990500 First citation in articleCrossrefGoogle Scholar

  • Pentzek, M., Fuchs, A., Abholz, H.-H., & Wollny, A. (2011). Awareness of local dementia services among general practitioners with academic affiliation. Aging Clinical and Experimental Research, 23, 241–243. https://doi.org/10.1007/bf03337750 First citation in articleCrossrefGoogle Scholar

  • Pentzek, M., Vollmar, H. C., Wilm, S., & Leve, V. (2017). Putting dementia awareness into general practice. Zeitschrift für Gerontologie und Geriatrie, 50, 44–47. https://doi.org/10.1007/s00391-017-1206-6 First citation in articleCrossrefGoogle Scholar

  • Prince, M. J., Wimo, A., Guerchet, M. M., Ali, G. C., Wu, Y.-T., & Prina, M. (2015). World Alzheimer report 2015 – The global impact of dementia. London, UK: Alzheimer’s Disease International. First citation in articleGoogle Scholar

  • Reddemann, L. (2003). Imagination als heilsame Kraft. Hör-CD mit Übungen zur Aktivierung von Selbstheilungskräften (Reihe Leben lernen Nr. 288). Stuttgart, Germany: Pfeiffer bei Klett-Cotta. First citation in articleGoogle Scholar

  • Schultz, T.Putze, F.Kruse, A. (Eds.) (2014). Technische Unterstuetzung fuer Menschen mit Demenz: Symposium 30.09.–01.10. 2013. KIT Scientific Publishing. First citation in articleGoogle Scholar

  • Sclan, S., & Reisberg, B. (1992). Functional Assessment Staging (FAST) in Alzheimer’s Disease: Reliability, Validity, and Ordinality. International Psychogeriatrics, 4(3), 55–69. https://doi.org/10.1017/S1041610292001157 First citation in articleCrossrefGoogle Scholar

  • Strohmaier, U., Keller, F., Kilimann, I., Michalowsky, B., Wucherer, D., Zwingmann, I., … Thyrian, J. R. (2018). Patients with dementia in primary care: Who is referred to a neurologist/psychiatrist and what patient-oriented factors are associated with the visit? Journal of Alzheimer’s Disease (Preprint), 64(3), 925–932. https://doi.org/10.3233/JAD-180196 First citation in articleCrossrefGoogle Scholar

  • Thyrian, J. R., Eichler, T., Pooch, A., Albuerne, K., Dreier, A., Michalowsky, B., … Hoffmann, W. (2016). Systematic, early identification of dementia and dementia care management are highly appreciated by general physicians in primary care: Results within a cluster-randomized-controlled trial (DelpHi). Journal of Multidisciplinary Healthcare, 9, 183–190. https://doi.org/10.2147/jmdh.s96055 First citation in articleCrossrefGoogle Scholar

  • Thyrian, J. R., Fiß, T., Dreier, A., Böwing, G., Angelow, A., Lueke, S., … Hoffmann, W. (2012). Life- and person-centred help in Mecklenburg-Western Pomerania, Germany (DelpHi): Study protocol for a randomised controlled trial. Trials, 13(1), 56. https://doi.org/10.1186/1745-6215-13-56 First citation in articleCrossrefGoogle Scholar

  • Thyrian, J. R., Hertel, J., Wucherer, D., Eichler, T., Michalowsky, B., Dreier-Wolfgramm, A., … Hoffmann, W. (2017). Effectiveness and safety of dementia care management in primary care: A randomized clinical trial. JAMA Psychiatry, 74, 996–1004. https://doi.org/10.1001/jamapsychiatry.2017.2124 First citation in articleCrossrefGoogle Scholar

  • Thyrian, J. R., & Hoffmann, W. (2012). Dementia care and general physicians: A survey on prevalence, means, attitudes and recommendations. Central European Journal of Public Health, 20, 270–275. First citation in articleCrossrefGoogle Scholar

  • Turner, S., Iliffe, S., Downs, M., Wilcock, J., Bryans, M., Levin, E., … O’Carroll, R. (2004). General practitioners’ knowledge, confidence and attitudes in the diagnosis and management of dementia. Age and Ageing, 33, 461–467. https://doi.org/10.1093/ageing/afh140 First citation in articleCrossrefGoogle Scholar

  • Vickrey, B. G., Mittman, B. S., Connor, K. I., Pearson, M. L., Della Penna, R. D., Ganiats, T. G., … Lee, M. (2006). The effect of a disease management intervention on quality and outcomes of dementia care: A randomized, controlled trial. Annals of Internal Medicine, 145, 713–726. https://doi.org/10.7326/0003-4819-145-10-200611210-00004 First citation in articleCrossrefGoogle Scholar

  • Winblad, B., Amouyel, P., Andrieu, S., Ballard, C., Brayne, C., Brodaty, H., … Zetterberg, H. (2016). Defeating Alzheimer’s disease and other dementias: A priority for European science and society. The Lancet Neurology, 15, 455–532. https://doi.org/10.1016/s1474-4422(16)00062-4 First citation in articleCrossrefGoogle Scholar

  • World Health Organization. (2012). Dementia: A public health priority. Geneva: Author. Retrieved from http://www.who.int/iris/handle/10665/75263 First citation in articleGoogle Scholar