Waldorff etal 2003;14 Denmark | 413 GPs in intervention, 122 in control group | GPs identified from medical association and organisational database | Assessment of a multifaceted strategy to implement guidelines | Controlled before and after study | Included dementia screening, thyroid function and vitamin B12 tests, cognitive testing and referrals to specialists; also questionnaire examining acceptability of guidelines | No significant difference between control and intervention group was found in the number of diagnostic evaluations undertaken, the number of ordered, orthe amount of cognitive testing performed. Most GPs had read the guidelines and found them applicable | Aftera multifaceted strategy for implementation, there was no improvement in the adherence to a guideline for diagnosing dementia. However, the outcomes were measured only 4-7 months after implementation, and while the intervention was delivered at GP level, the outcomes were measured at practice level |
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Downs etal 2006;16 central Scotland and London | 35 practices | Local group meetings, postaland phone invitations, practice visits | Threearms: (1) tutorial on CD-ROM, (2) decision-support software, (3) practice-based workshops | Unblinded, cluster randomised before and after controlled trial | Detection rates. Concordance with guidelines | Significant increase in the detection of dementia inarms 2 and 3. No improvement in adherence to guidelines | Might be useful to examine potential cumulative effects of combining educational interventions |
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Rondeau etal 2008;19 France | 684 GPs, 214 specialists, 3021 patients | Random selection from a list of GPs throughout France | Group educational meeting, and training in use of neuro psychological tests | Cluster randomised controlled trial | Primary outcome: suspicion of dementia by GP. Secondary outcome: diagnosis of dementia by GP | No difference in diagnosis of dementia in intervention group | Education ineffective |
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Chodosh etal 2006;18 US | 166 primary care clinics | Questionnaires sent to all primary care health providers at 16 clinics | Survey of knowledge, attitudes, perceptions following participation in the ACCESS study (Vickreyet al24) | Survey following a cluster randomised controlled trial of a care management intervention | Practitioners' knowledge about capacity determination, evaluation, treatment and patient safety. Measures of attitude, and perceptions of quality of care | Intervention group knew more about determining capacity and more felt that management of dementia patients in primary care was difficult; no other difference in knowledge, attitudes or perceptions of quality of care | Care management programmes may have a positive effect on care despite lack of educational gain |
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Wenger et al 2009;1 US | 357 intervention and 287 control community-dwelling patients | Patients aged >75 years, with difficulty in falls, continence or cognition; two medical groups participated each having two sites, with one acting as a control and one as an intervention site | Patients' problems were identified bya telephone call, then the physician triggered a condition-specific process of management and resulted with formulating a plan for the patient. Physicians in the intervention group had a 3-hour educational session on Assessing Care of Vulnerable Elders (ACOVE) quality indicators. Patients also completed questionnaires. Data were collected from medical records. Patients also completed questionnaires. Data were collected from medical records | Controlled trial | Percentage of quality indicators met after 13 months of medical record extraction | For cognitive impairment, care as triggered by quality indicators did not differ; however, more attention was given to caregiver education, decision-making capacity, and discussion about driving occurred in the intervention group | Care did not improve for patients with cognitive impairment. All physicians provided more recommended care for patients who presented with their symptoms (compared to those identified by screening) |
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Vollmar et al 2010;20 Germany | 389 GPs from 26 Quality Circles (QCs) | All QCs within a 50km radius of Witten University were contacted by telephone or letter to the QC moderator. GPs were recruited at QC meetings, and required to participate in an extra session and have access to the internet. A control group was used for comparison | QCs were randomly allocated to either arm of the trial: online learning + structured case discussion (‘blended learning’) or lecture + structured case discussion. Both groups received pocketbooks of the guidelines. Control group received only the pocketbook. Knowledge tests were carried out pre-and post- intervention, and at 6 months | Cluster randomised controlled trial | Primary outcome: knowledge gain from before to afterthe intervention. Secondary outcome: comparison of knowledge gain of the two groups. Both groups showed a significant gain in knowledge following the interventions. However, there was no difference in knowledge gains between the two groups | Sub-group analysis showed that GPs who self-reported using the online learning had significant knowledge gain compared with theothergroup. The control group showed a knowledge gain that was significantly less than the intervention groups | Blended learning’ was not more effective than traditional learning in improving dementia knowledge in GPs. However, when GPs self-report use of online modules, results suggest that blended learning techniques could be more effective |
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Perry et al 2008;13 Holland | 151 patients | 54 GPs recruited patients >70 years into Dutch EASYcare study Geriatric Intervention Program (DGIP) | Secondary analysis of data examining whether the DGIP (an in-home assessment) improves rates of detection of dementia in primary care. In-home assessment performed by specialist nurse, assessed function, mood, cognition, caregiver burden. A management plan was formulated | Blinded, randomised controlled trial | Primary outcome: the number of new dementia diagnoses. Secondary outcome: the level of under-registration of dementia cases | The number of dementia diagnoses in control group (9%) was significantly less than those in intervention group (29%) (P= 0.02) | An in-home assessment and management programme is effective in detecting dementia in the primary care setting compared with controls of usual care |
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Callahan etal 2006 ;26 US | 153 patients with Alzheimer's disease | Primary care centres | Collaborative care management | Randomised controlled trial | Neuro psychiatric inventory (NPI) cognitive function, carerstress, service use | Intervention group had lower NPI scores but no difference in depression, cognitive status, or functional scores. Carers showed less stress. Intervention group had higher number of contact visits with physician/nurse, but no difference in hospital or nursing home admissions | Collaborative care can reduce behavioural/psychological symptoms in patients, and stress in carers |
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Vickrey etal 2006;24 US | 408 patient and care-giver dyads from 18 clinics | Patients identified from organisational database | Dementia care manager with web-based support software for care planning, and coordination. Interactive educational seminars for practitioners in intervention group | Cluster randomised controlled trial | Primary: adherence to guidelines. Secondary: use of cholinesterase inhibitors, patient quality of life (QoL), caregivers knowledge. QoL, social support and confidence | Intervention group care more adherent to guidelines and got more community services, were prescribed more cholinesterase inhibitors. Caregivers were more confident in intervention group | Systems change by introducing care managers can improve quality of care, but is costly |
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Fortinsky etal;27 2009 US | 84-caregivers | Family caregivers of patients with dementia were recruited from the Alzheimer's Association, and primary care | Intervention group received educational materials which were discussed with a dementia care consultant | Cluster randomised trial | Primary outcome: admission to a nursing home in the study period. Secondary outcomes: caregiverself-efficacy, caregiver burden, depression, health, satisfaction with the service | Intervention group were 40% less likely to end up in nursing home than control, but this did not achieve statistical significance | No difference was found between groups for secondary outcomes. Inadequately powered study |
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Clark etal 2004 ;25 US | 89 participants with a symptom of memory loss or diagnosis of dementia, but no mention of how many in control and how many in intervention groups | Patients registered with Kaiserwith diagnosis of dementia on medical records or symptoms indicative of cognitive impairment | Intervention group received care-consultation: telephone interaction between Alzheimer's Association staff and patient/caregiver | Randomised controlled trial | Hospital admissions A&E visits, number of physician contacts satisfaction with service, depression, strain on patient | Intervention group reported more memory symptoms, but were less likely to have hospital admissions or A&E visits, and had fewer physician contacts. Also experienced less embarrassment, isolation and relationship strain | Overall, patients who had a care consultant had lower levels of negative consequences from memory problems, and reduced usage of certain services |